Director System Revenue Integrity

Cape Cod Healthcare•Hyannis, MA

About The Position

This role is responsible for leading the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions, ensuring the implementation of action plans where performance is not meeting expectations, and reviewing KPI expectations annually. The position also involves developing, implementing, and overseeing effective and consistent operational policies, processes, tools, and educational materials within all Revenue Integrity functional areas. The Director will oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology enablers and proactive internal audits/reviews of charging practices. Ensuring the CDM is compliant with regulatory and payer requirements and that all services provided have an established charging and reconciliation methodology is also a key responsibility. The role ensures Revenue Integrity employees across all functions comply with established policies, processes, and quality assurance programs, identifies potential process improvements in charge capture functions, and leads the design and implementation as required. Monitoring and facilitating service level agreements (“SLAs”) between Revenue Integrity operations and other related functions within both Revenue Cycle and Clinical operations, including confirmation that charge review queues/requests are managed appropriately, is crucial. Building strong relationships and facilitating productive communication between key Revenue Cycle stakeholders, including peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance), is essential. The Director will develop, implement, and manage efficient and effective operational policies, procedures, processes, and performance monitoring across all revenue integrity functions. Ensuring audit of denial management processes occurs consistently and coordinating with peers across the revenue cycle organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs are also key duties. The role oversees, measures, and reports ongoing financial and operational performance of Revenue Integrity, audit and appeals outcomes, and denial management across CCHC. Support for CCHC strategic initiatives that require involvement from revenue integrity functions is also required. Assessing direct reports’ performance on a consistent basis and providing feedback to reward effective performance and enable proactive performance improvement steps is part of the role. Leading the establishment and implementation of Key Performance Indicators (“KPIs”) for audit and appeal functions, ensuring the implementation of action plans where performance is not meeting expectations, and reviewing KPI expectations annually are also responsibilities. Developing reporting to support the transparency of audit and appeals outcomes, identifying potential process improvements within the audit and appeals workflows, and leading the design and implementation as required are also part of the role. Developing and monitoring productivity metrics for all Revenue Integrity functional areas, overseeing payment variance team members and workflows, seeking opportunities to address and remedy system and/or payer related issues causing payment variances, and developing reporting to identify and monitor root cause payment variance issues are also key functions. Reporting payment variances to executive leadership, challenging current working practices, identifying process improvement opportunities, and presenting recommendations and solutions to management are expected. The role also engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

Requirements

Bachelor's degree in Business Administration, Healthcare Management or related discipline and or equivalent experience.
Minimum of five to seven years of relevant experience with a track record of progressively responsible positions in a complex healthcare organization such as a multi-hospital system, large group practice or a major healthcare consulting firm preferred.
Minimum of three to five years of supervisory/management experience.
Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies, and industry best practices.
Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle management to identify trends, produce reliable forecasts and projections.
Strong analytical and critical-thinking, organizational, and business process optimization skills, with in-depth ability to develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
Excellent communication, leadership, delegation, and interpersonal skills.
Above average understanding of how, when, and to what extent different hospital departments relate to and communicate with one another.

Responsibilities

Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions; ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations annually and adjust appropriately; recognize areas of excellence.
Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational materials within all Revenue Integrity functional areas.
Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology enablers and proactive internal audits/reviews of charging practices.
Ensure that the CDM is compliant with regulatory and payer requirements and that all services provided have an established charging and reconciliation methodology.
Ensure Revenue Integrity employees across all functions comply with established policies, processes, and quality assurance programs.
Identify potential process improvements in charge capture functions, and lead the design and implementation as required.
Monitor and facilitate service level agreements (“SLAs”) between Revenue Integrity operations and other related functions within both Revenue Cycle and Clinical operations. This includes confirmation that charge review queues/ requests are managed appropriately.
Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance).
Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance monitoring across all revenue integrity functions.
Ensure audit of denial management processes occurs consistently and coordinate with peers across the revenue cycle organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs.
Oversee, measure, and report ongoing financial and operational performance of Revenue Integrity, audit and appeals outcomes and denial management across CCHC.
Support CCHC strategic initiatives that require involvement from revenue integrity functions as required.
Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for audit and appeal functions; ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations annually and adjust appropriately; recognize areas of excellence.
Develop reporting to support the transparency of audit and appeals outcomes
Identify potential process improvements within the audit and appeals workflows and lead the design and implementation as required.
Develop and monitor productivity metrics for all Revenue Integrity functional areas
Oversees payment variance team members and workflows
Seeks opportunities to address and remedy system and/or payer related issues causing payment variances
Develop reporting to identify and monitor root cause payment variance issues
Reports payment variances to executive leadership
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management.
Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.