Senior Director - Revenue Integrity
Apply NowCompany: Maine Medical Center
Location: Scarborough, ME 04074
Description:
Description
MaineHealth Corporate
Management/Leadership
Req #: 3505
Summary
Summary:
Under the general direction and guidance of the VP, Revenue Cycle, the Sr. Director of Revenue Integrity is responsible for developing standards and ensuring the integrity of the integrated professional and facility revenue charge capture; includes all aspects of the Charge Master Description and fee schedule formulation(s), review and maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across the Maine Health Enterprise; policies and procedures development, modification and maintenance. The Sr. Director of Revenue Integrity also is responsible for developing and implementing a strategic approach of implementing standardization and controls across the MaineHealth system including structure, education and process. This will assure the system operates in a lean standard manner and information is disseminated consistently and timely ensuring charges are maximized for reimbursement. The Sr. Director of Revenue Integrity will provide oversight and insight for other Revenue Integrity leaders throughout the system and provide insight on governmental audits such as RAC, MIC, etc and Third Party Payor audits. The Sr. Director of Revenue Integrity also participates in compliance related activities.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
1. Education: Bachelor's Degree required in Health Information Management (RHIA), Business Administration, Finance, Financial Management, Finance Administration, Nursing or Information System Management. Master's degree preferred. 2. License/Certification: Certification in at least one of the following weighted in order: RHIA, RHIT, RN, CCA, CCS, CIC, CCS P, ACPC, CPC P, CPC H or Other coding / RCM Certification at the discretion of the VP will be allowed. Must obtain or be working towards certification within one year of hire if not certified at time of hire. 3. Experience: Minimum of ten (10)+ years of progressive revenue cycle experience or an RN with leadership experience. 4. Proficiencies: Analyze and influence appropriate action in all areas of reimbursement, by performing appropriate reviews, investigating trends and patterns and providing education regarding charge capture and charge reconciliation. A3 process skills to develop root cause and corrective actions for teams Conducts audits, on all areas treating patients to ensure all professional and facility billable charges are captured Must have excellent verbal and written communication skills in order to present and explain information to customers in a desired manner consistent with procedures. Direct, set vision, and define roles and responsibilities for the Revenue Integrity Department. Oversee the management of the consolidated professional and hospital Charge Description Master Fee Schedules. 5. Specialized Knowledge: Demonstrated knowledge of various hospital and professional fee coding systems including ICD 9/10 CM, CPT and HCPCS. Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule. Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments. Strong quantitative, analytic, and problem solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions. Strong organizational skills to keep track of multiple priorities of highly detailed information Ability to lead teams, mentor and support development of resources.
Additional Information
With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it.
We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.
MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you're looking to build a career in a place where people help one another deliver best-in-class care, apply today.
MaineHealth Corporate
Management/Leadership
Req #: 3505
Summary
Summary:
Under the general direction and guidance of the VP, Revenue Cycle, the Sr. Director of Revenue Integrity is responsible for developing standards and ensuring the integrity of the integrated professional and facility revenue charge capture; includes all aspects of the Charge Master Description and fee schedule formulation(s), review and maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across the Maine Health Enterprise; policies and procedures development, modification and maintenance. The Sr. Director of Revenue Integrity also is responsible for developing and implementing a strategic approach of implementing standardization and controls across the MaineHealth system including structure, education and process. This will assure the system operates in a lean standard manner and information is disseminated consistently and timely ensuring charges are maximized for reimbursement. The Sr. Director of Revenue Integrity will provide oversight and insight for other Revenue Integrity leaders throughout the system and provide insight on governmental audits such as RAC, MIC, etc and Third Party Payor audits. The Sr. Director of Revenue Integrity also participates in compliance related activities.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
1. Education: Bachelor's Degree required in Health Information Management (RHIA), Business Administration, Finance, Financial Management, Finance Administration, Nursing or Information System Management. Master's degree preferred. 2. License/Certification: Certification in at least one of the following weighted in order: RHIA, RHIT, RN, CCA, CCS, CIC, CCS P, ACPC, CPC P, CPC H or Other coding / RCM Certification at the discretion of the VP will be allowed. Must obtain or be working towards certification within one year of hire if not certified at time of hire. 3. Experience: Minimum of ten (10)+ years of progressive revenue cycle experience or an RN with leadership experience. 4. Proficiencies: Analyze and influence appropriate action in all areas of reimbursement, by performing appropriate reviews, investigating trends and patterns and providing education regarding charge capture and charge reconciliation. A3 process skills to develop root cause and corrective actions for teams Conducts audits, on all areas treating patients to ensure all professional and facility billable charges are captured Must have excellent verbal and written communication skills in order to present and explain information to customers in a desired manner consistent with procedures. Direct, set vision, and define roles and responsibilities for the Revenue Integrity Department. Oversee the management of the consolidated professional and hospital Charge Description Master Fee Schedules. 5. Specialized Knowledge: Demonstrated knowledge of various hospital and professional fee coding systems including ICD 9/10 CM, CPT and HCPCS. Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule. Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments. Strong quantitative, analytic, and problem solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions. Strong organizational skills to keep track of multiple priorities of highly detailed information Ability to lead teams, mentor and support development of resources.
Additional Information
With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it.
We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.
MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you're looking to build a career in a place where people help one another deliver best-in-class care, apply today.