Director Revenue Integrity
Apply NowCompany: Kootenai Health
Location: Coeur D Alene, ID 83816
Description:
Director Revenue Integrity
Job Code: 29217
Position Summary
The Director, Revenue Integrity is responsible for organizing, leading, and improving revenue cycle performance throughout Kootenai Health. This position oversees the entire revenue integrity function, leading a team to develop strategies, optimize billing and coding practices, ensure compliance with regulations, and maximize revenue capture by identifying and mitigating potential revenue leakage across all clinical departments, while maintaining the integrity of patient billing practices.
Responsibilities
Develops, coordinates, implements and oversees the revenue integrity program, functions, and team
Ensures the effectiveness of revenue integrity, including overall consistency and integration of revenue integrity activities throughout the organization
Supports and facilitates the annual charge description pricing review in alignment with finance and reimbursement policies and guidelines, serves as a point of contact for strategic pricing vendors
Supports clinical departments related to new revenue initiatives, such as being the subject matter expert in the development of new CDMs to support clinical service offerings
Drives communication of CDM changes to impacted clinical departments
Ensures alignment of revenue integrity with applicable policies and procedures and all applicable laws, standards and regulations
Reviews, revises, and develops policies for adoption via institutional processes, as appropriate to compliment and reinforce revenue integrity
Oversees the revenue integrity team daily work and associated functions including, but not limited to, charge entry, work queue management, charge capture, payer plan coordination and audits
Develops best practices for clinical areas to drive greater financial performance
Identifies continuous improvement opportunities on charge capture, collaboration across departments and accountability on charging practices
Serves as a key resource for finance leaders on revenue reporting, general ledger mapping for revenue departments, and other hospital revenue-related inquiries
Collaborates with Finance, Revenue Integrity, CDM, Compliance, Decision Support, Care Sites, and other departments to standardize and optimize charging workflows, revenue processes, billing, denial management, and collections, aiming to minimize revenue leakage
Works with department managers to recommend charge master updates in compliance with regulatory guidelines, ensuring standardization where feasible
Analyzes new procedures, assess potential revenue, costs, and income, and provide recommendations while participating in decision-making regarding the addition or elimination of services
Ensures the effectiveness of the revenue integrity program, maintaining overall consistency and integration of integrity activities across the organization
Oversees the management of the Revenue Integrity staff, ensuring accurate charge audits, revenue cycle support services, and education on proper charging and government billing edits (NCCI, MUEs, Coding Pairs, LCD, NCD)
Supports and leads the enhancement of charge description master (CDM) activities through integrated revenue cycle applications, reviewing and optimizing organizational CDM structures to ensure they accurately reflect services and supplies provided, in line with current industry best practices
Develops specific objectives and performance standards for all team members
Performs other related duties as assigned
Relies on experience and judgment to plan and accomplish goals
Regular and predictable attendance is an essential job function
Competent to meet age-specific needs of the unit assigned
Requirements and Minimum Qualifications
Bachelor's degree in Business Administration required
Master's Degree in Health Administration or Business Administration preferred
Minimum 10 years' leading Revenue Integrity, with increasing and progressive responsibility required
Extensive experience with EPIC Systems, preferably with HB Resolute Hospital Billing certification or significant hands-on experience
Coding certification (CCS, CPC, COC) or advanced certification in Health Information (RHIT or RHIA), and/or HFMA Certified Healthcare Financial Professional (CHFP), or NAHRI Certification in Healthcare Revenue Integrity (CHRI) preferred
Ability to analyze data, identify discrepancies, and optimize processes to ensure revenue integrity accuracy and efficiency
Proven experience in leading change initiatives
Demonstrated attention to detail with excellent organizational and analytical skills, and the ability to adapt to change
Proficient in team building, conflict resolution, group interaction, and project management
Strong quantitative, analytical, and communication skills
Working Conditions
Must be able to lift and move up to 10lbs
Must be able to maintain a sitting position
Typical equipment used in an office job
Must be able to stoop, crouch, or bend
Repetitive movements
Job Code: 29217
Position Summary
The Director, Revenue Integrity is responsible for organizing, leading, and improving revenue cycle performance throughout Kootenai Health. This position oversees the entire revenue integrity function, leading a team to develop strategies, optimize billing and coding practices, ensure compliance with regulations, and maximize revenue capture by identifying and mitigating potential revenue leakage across all clinical departments, while maintaining the integrity of patient billing practices.
Responsibilities
Develops, coordinates, implements and oversees the revenue integrity program, functions, and team
Ensures the effectiveness of revenue integrity, including overall consistency and integration of revenue integrity activities throughout the organization
Supports and facilitates the annual charge description pricing review in alignment with finance and reimbursement policies and guidelines, serves as a point of contact for strategic pricing vendors
Supports clinical departments related to new revenue initiatives, such as being the subject matter expert in the development of new CDMs to support clinical service offerings
Drives communication of CDM changes to impacted clinical departments
Ensures alignment of revenue integrity with applicable policies and procedures and all applicable laws, standards and regulations
Reviews, revises, and develops policies for adoption via institutional processes, as appropriate to compliment and reinforce revenue integrity
Oversees the revenue integrity team daily work and associated functions including, but not limited to, charge entry, work queue management, charge capture, payer plan coordination and audits
Develops best practices for clinical areas to drive greater financial performance
Identifies continuous improvement opportunities on charge capture, collaboration across departments and accountability on charging practices
Serves as a key resource for finance leaders on revenue reporting, general ledger mapping for revenue departments, and other hospital revenue-related inquiries
Collaborates with Finance, Revenue Integrity, CDM, Compliance, Decision Support, Care Sites, and other departments to standardize and optimize charging workflows, revenue processes, billing, denial management, and collections, aiming to minimize revenue leakage
Works with department managers to recommend charge master updates in compliance with regulatory guidelines, ensuring standardization where feasible
Analyzes new procedures, assess potential revenue, costs, and income, and provide recommendations while participating in decision-making regarding the addition or elimination of services
Ensures the effectiveness of the revenue integrity program, maintaining overall consistency and integration of integrity activities across the organization
Oversees the management of the Revenue Integrity staff, ensuring accurate charge audits, revenue cycle support services, and education on proper charging and government billing edits (NCCI, MUEs, Coding Pairs, LCD, NCD)
Supports and leads the enhancement of charge description master (CDM) activities through integrated revenue cycle applications, reviewing and optimizing organizational CDM structures to ensure they accurately reflect services and supplies provided, in line with current industry best practices
Develops specific objectives and performance standards for all team members
Performs other related duties as assigned
Relies on experience and judgment to plan and accomplish goals
Regular and predictable attendance is an essential job function
Competent to meet age-specific needs of the unit assigned
Requirements and Minimum Qualifications
Bachelor's degree in Business Administration required
Master's Degree in Health Administration or Business Administration preferred
Minimum 10 years' leading Revenue Integrity, with increasing and progressive responsibility required
Extensive experience with EPIC Systems, preferably with HB Resolute Hospital Billing certification or significant hands-on experience
Coding certification (CCS, CPC, COC) or advanced certification in Health Information (RHIT or RHIA), and/or HFMA Certified Healthcare Financial Professional (CHFP), or NAHRI Certification in Healthcare Revenue Integrity (CHRI) preferred
Ability to analyze data, identify discrepancies, and optimize processes to ensure revenue integrity accuracy and efficiency
Proven experience in leading change initiatives
Demonstrated attention to detail with excellent organizational and analytical skills, and the ability to adapt to change
Proficient in team building, conflict resolution, group interaction, and project management
Strong quantitative, analytical, and communication skills
Working Conditions
Must be able to lift and move up to 10lbs
Must be able to maintain a sitting position
Typical equipment used in an office job
Must be able to stoop, crouch, or bend
Repetitive movements