Director-Revenue Integrity

General Summary

Coordinates and directs the corporate Revenue Integrity Team. Serves as a leader in the revenue cycle and is responsible for supporting the revenue capture processes by partnering with the clinical management within the health system. Provides technical expertise, coaches and ensures the accuracy of all charge master data elements such as CPT, HCPCS and revenue codes. Supports the integration of a system wide charge description master and charge capture efforts. Formulates and defines system scope and objectives based on both user needs and a good understanding of applicable business requirements to support the business strategies, strategic vision and goals of the System.

Duties and Responsibilities

Essential Functions:

• Provides direct oversight and maintenance of system wide charge description master.
• Provides leadership and direction to Revenue Integrity Supervisors, Medical Revenue Analysts, Sr. Medical Review Analysts and Nurse Auditors.
• Drive process optimization across health system for integration of charges between clinical and financial systems.
• Direct and participate in complex projects related to revenue cycle initiatives.
• Validates and educates clinical service areas on appropriate charging protocols in accordance with regulatory requirements.
• Analyzes data for root cause analysis on complex charge capture design issues. Utilizes software maintenance and report writing tools, as required.
• Based upon extensive knowledge, validates the use of CPT/HCPCS/UB04 revenue coding, modifiers, CMS billing regulations, and APCs as appropriate.
• Act as clinical/coding expert for Revenue Integrity staff.
• Implements related organizational initiatives in a manner that is inclusive and participatory.
• Performs charge capture audits as necessary.
• Monitors department's key performance indicators.
• Supports and manages expansion of revenue cycle enhancements to support health system growth.

Common Expectations:

• Maintains and/or creates policies and procedures and objectives related to charge capture policies and procedures
• Continuously updates information technology skills and knowledge and maintains professional growth and development.
• Extensive knowledge of charge creation, regulations, charge capture and reconciliation in a health care environment.
• Selects, trains/orients, assigns department staff, evaluates performance, and makes recommendations for personnel actions.
• Coordinates and integrates services of teams, with other departments/service lines/entities, and with the System's primary functions. Participates in the selection of outside services (if needed).
• Shares leadership responsibility and accountability for the department's budget with the Director-Revenue Analytics.
• Continuously assesses and improves teams. Maintains appropriate quality control/assessment programs (if applicable).
• Maintains appropriate records, reports, and files as required.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• Bachelors Degree Required

Work Experience:

• 5 years Charge master maintenance management experience with some personnel management experience. Required and
• Must have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle. Required

Licenses:

• Certified Coding Specialist Upon Hire Required or
• Certified Professional Coder Upon Hire Required

Knowledge, Skills, and Abilities:

• Must have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle.
• Able to work well in a team environment as a member and/or leader.
• Able to accept responsibility.
• Thorough knowledge of relevant specialty areas.
• Analytical and logical approach to solving problems.
• Clarity and discipline in communication skills- written and verbal.
• Capable of imaginative and abstract reasoning.
• Advanced trouble shooting skills.
• Self reliant and capable of independent work.

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)