Director Revenue Integrity

Overview

The Director of Revenue Cycle provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies to ensure the department and organization maximizes performance, achieves goals, and delivers excellent internal and external customer service.

This position provides overall operational leadership and oversight of assigned Revenue Cycle functions and ensures execution of daily functions. Strategic programs and priorities to achieve leading practice performance are a key priority in this role acting as a primary contributor to strong financial health of the organization. The role will possess a strong understanding of financial application and other technical solutions to leverage digital workflow in ensuring maximum efficiency and outcomes. Additionally, the role will maintain understanding of current regulatory and payer requirements and ensuring team maintains current in their application of such requirements in work completed.

Director serves as a subject matter expert and accountable leader with technical competence for enterprise standardization and optimization, leading in world class performance and collaborating with team and partnerships. The role will lead in collaboration forums as well as act in designated liaison roles with partners and stakeholders to ensure comprehensive awareness, alignment, decision making, policy, metric transparency and performance that results in compliant and trusted outcomes for patients, providers, workforce and system.

Overall responsibilities include development and oversight of operational metrics, people, plans, and programs including financial, systems/processes and internal controls for assigned Revenue Cycle functions. In addition, this position ensures that the assigned Revenue Cycle functions actively engage in continuous process improvement to enhance performance, create efficiencies, and support exceptional patient/ family experience related to quality access and communication in the patient's financial journey. Focuses on quality, consistent, simplified, convenient and personalized service that compliments the patient's care and assures organizational policies and standards are followed by team and partners supporting the organization. Understands, advocates (consumerism) and promotes transparency and informed decision making in compliance with industry standards and on behalf of the patient /patient's financial rights.

This role acts as a champion for workforce through active engagement leveraging organizational commitments and will lead by example. Continued investment and focus on development, growth and retention will be a vital investment while creating opportunities for department staff.

Ultimately responsible for compliance and quality standards for assigned Revenue Cycle functions.

Responsibilities/Job Description

* Provides Strategic Direction for management of the Charge Description Master (CDM), fee schedule pricing and system-wide charge capture and charge reconciliation. This work facilitates accurate financial reporting for the organization, supports capture and categorization of patient care revenue by department or service line, provides data to manage resource utilization and inventory management, and supports Medicare and Medicaid cost reporting.
* Performs continuous assessment to help identify strengths, weaknesses, opportunities, and threats to revenue cycle functions. Identifies, evaluates, develops, and implements strategies and tactics to achieve organizational objectives.
* Establishes performance metrics and KPI's that align with benchmark standards and result in daily maximum output supporting CDM, charge capture and fee schedule pricing for the organization. Ensures leaders and team monitor and measure performance that results in leading practice outcomes for the organization.
* Oversees functions, priorities, and staff effectiveness to ensure maximum efficiency, achievement of outcomes and work that is executed in a compliant, accurate and timely manner.
* Responsible for managing effective and efficient charge capture, charge master and fee schedule pricing operations including people, processes and technology that results in leading practice clean and compliant claim creation. Leads employees and influences stakeholders to follow appropriate standards, workflows and systematic improvement processes.
* Leads the department to ensure fully vetted, tested, and approved people, process and technology edits and changes that result in compliance with CPT/HCPC coding, National Uniform Billing Committee (NUBC) revenue codes, billing, payor, and regulatory requirements.
* Manages department leadership and teams. Ensures organizational structure, job descriptions and performance are optimized. Hires, orients, and trains leadership team. Assures development and implementation of key productivity and quality standards for department processes. Establishes and works with leadership team to monitor and manage productivity and quality as well as creating efficiency leveraging technology to achieve leading practice performance.
* Guides and implements framework with leadership team that ensures routine evaluation of staff performance, meaningful feedback, coaching, and corrective action when necessary to support growth, development, and high performance.
* Works with leadership and team to ensure appropriate staff education, training and certification while ensuring a culture of diversity, equity and inclusion. Identifies opportunities and works with leadership and staff to implement plans to improve staff engagement. Establishes, maintains, and ensures appropriate education vehicles for team, remaining current with CPT/HCPC coding regulations and payer billing requirements.
* Performs succession planning and individualized plans to provide development opportunities within the organization. Understands and follows human resource policies and procedures.
* Oversees the activities of outsourced/ partnership with external vendors including implementation and on-going performance. Represents Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities.
* Provides oversight to ensure compliance with established laws, regulations, practices, and procedures. Maintains self and team knowledge of, and complies with, all relevant laws, regulations, policies, procedures, and standards.
* Monitors Finances. Develops and monitors budgets for assigned areas. Ensures key performance indicators are monitored and being met. identifies, evaluates, and implements, as appropriate, cost reduction opportunities Meets budget expectations. Develops and manages financial forecasts for entity. Along with senior management team, accountable for closing gap between run rate and target. Plans, directs, and oversees annual budget development and ongoing management for all areas of responsibility.
* Develops Strong Working Relationships. Leads or participates in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance.
* Fosters a culture of improvement, efficiency, and innovative thinking.
* Creates structures and processes within team and internal customers to continuously optimize and improve processes to mitigate delays, errors and defects that result in denials and write-offs and improve transparency of the patient's financial journey.
* Creates and cultivates culture of analysis, trends, issues, risk and resolution tracking with team and customers to identify patterns and appropriate solutions in a timely manner
* Performs other responsibilities as needed/assigned.

Qualifications

Required

Education

* Bachelor's degree. Four years of experience in an applicable field may substitute for a bachelor's degree.

Experience

* Total of 7 years of relevant department experience
* 5 years of progressive leadership experience
* Experience engaging in implementation of new processes, enterprise-wide initiatives and/or Technologies

License/Certification/Registration

* Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Hospital Billing Charging, Resolute Professional Billing Claims, Resolute Hospital Billing Claims, OR ability to obtain certification within one year of hire.

Preferred

Education

Bachelor's or Master's degree.

Experience

* 7 years progressive leadership experience in revenue cycle functional area
* Experience leading a department of multiple leaders

License/Certification/Registration

* RHIA, RHIT, CHRI, CCS, CPC certification
* Epic certification in Resolute Hospital Billing Charging