Director, Professional Revenue Integrity

2 weeks ago

Houston, United States Memorial Hermann Health System Full time

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

**Job Summary**

This position is responsible for overseeing and managing all aspects of professional service charges to secure the organization's revenue integrity. The Director, Professional Revenue Integrity is accountable for the execution of the leadership, development, vision, operational and fiscal management of the professional services revenue integrity department. Creating a culture of development, collaboration, and continuous improvement is essential in this position. This position is responsible for establishing department level productivity and quality standards. This position plans and oversees the completion of a full range of department activities including administrative and technical aspects of professional services revenue integrity supporting the design and implementation of effective systems to ensure accurate, compliant, and timely charging. This position maintains a thorough comprehension of revenue cycle processes including Charge Capture, Charge Reconciliation, Data Analytics, Performance Optimization, Pricing, Reimbursement and Professional Billing. Partnering with leadership in Revenue Cycle, Clinical Departments, Networking, and Finance is essential to revenue performance across the Physician Enterprise. This leader maintains current knowledge of regulatory requirements, billing guidelines, and industry standards of pricing, including market conditions, government rates, local demographics, and economics. This position typically reports to the Vice President, Physician Enterprise Revenue Cycle.

**Desired Skill Sets**:

- Must have EPIC experience
- Revenue Cycle manager or director level experience preferred
- Revenue Integrity experience highly preferred
- Prefer Bachelors degree in Healthcare Administration
- Heavy technical knowledge with an understanding of Revenue Cycle workflow, AR, etc.

**MINIMUM QUALIFICATIONS**

**Education**:Bachelor's degree in Healthcare Administration, Business Management, Accounting or related field preferred.

**Licenses/Certifications**:
Certification(s) preferred:

- Certified Professional Coder (CPC)
- Certified Medical Coder (CMC)
- Epic certification such as ARCR: Resolute Professional Billing Claims and Billing Readiness
- Project Management Professional (PMP)

**Experience / Knowledge / Skills**:

- Ten (10) years of Physician/Professional Billing experience with at least five (5) years in a management level position for a large health system required.
- Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system.
- Experience in Charge Capture, Charge Reconciliation, Charge Pricing, Charge Routing, and Reimbursement.
- Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10).
- Proven analytical ability, organizational and critical thinking skills to systematically analyze problems based on data analytics and devise appropriate courses of action.
- Proven track record of implementing business strategies while effectively managing details of complex, multi-faceted projects.
- Must possess strong communications skills to successfully collaborate and interact with internal/external team members, colleagues, and contacts of varying levels or backgrounds.
- Ability to supervise and train employees, including organizing, prioritizing, and scheduling work assignments to meet timelines; requiring leadership and mentoring skills to support department and employee development.
- Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding other office duties.

**PRINCIPAL ACCOUNTABILITIES**
- Oversees all facets of professional services revenue integrity processes to achieve and exceed best practice benchmarks.
- Partners with senior leadership and the Memorial Hermann Medical Group (MHMG) to establish and maintain industry-leading best practices to for overall revenue integrity including professional services coding and clinical documentation.
- Enhances financial performance by implementing process improvements, optimizing charge capture and reconciliation, and maximizing revenue to achieve optimal reimbursement for services rendered.
- Monitors governance of daily charge reconciliation procedures and engages departments in maintenance.
- Provides support and pricing methodology guidance through fee schedule

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