Director of Revenue Integrity

4 weeks ago

Boston, United States Codman Square Health Center Full time
Job Details

Job Location
1100 Washington Street - Boston, MA

Position Type
Full Time

Education Level
4 Year Degree

Job Category
Health Care

Description

Reporting to Chief Financial officer, Director of Revenue Integrity develops overall vision and implementation plans to effectively support organizational strategies for revenue management. Identifies and develops necessary infrastructure to support implementation of strategies. Coordinates efforts with key stake holders to standardize organization metrics, process, procedures, templates and collaborative tools as applicable to support revenue cycle including but not limited to manage third party billing vendor, enrollment department and collaborate all the departments' impact revenue cycle. In addition, the Director of Revenue will manage relationships with third party payer, ensure accurate and timely payments and in compliance with regulatory changes. The director will prepare relevant reports regarding trends in denials, self-pay collection and identify the cause of the non-collection and propose intervention strategy. In addition, the Director of revenue will also be responsible for OSV compliance including sliding scale implementation.

Primary Responsibilities:

•Provide leadership and direction to maximize revenue and ensure compliance with all appropriate regulatory bodies.
•Develop and implement strategic plans and goals to maximize the efficiency of the revenue cycle.
•Review and revise policies and procedures while focusing on continuous improvement and customer service.
•Implement and oversee new programs to reduce billing errors and maximize reimbursement.
•Investigate and serve as expert resource on compliance issues surrounding billing and coding.
•Understand contract nuances for each payer, analyze contractual reimbursement, research contractual questions and provide resolution to any issues.
•Ensure third party reimbursement grid and insurance fact sheet are updated.
•Assist with provision and analysis of monthly trend reports. Provide training and feedback to management on the use of these reports to ensure alignment with organizational goals.
•Proactively monitor revenue cycle reports and provide feedback to individual practices on an ongoing basis. This includes accounts receivable aging, days in accounts receivable, denials, payment variance analysis, claim hold reports, credit balances and adjustments to name a few.
•Ensure the staff receives additional training as needed on various reimbursement functions including but not limited to verification of insurance using carrier websites, charge entry and posting, and scheduling.
•Have advanced knowledge of all modules relating to the medical billing system and billing system's reports to understand the cause and effect of all functions.
•Build and maintain relationships with all provider and contracting representatives
•Perform cost/benefits analysis for decisions with multiple options.
•Understands security issues with EMR.
•Provide excellent customer service to patients, staff, providers and co-workers.
•Provide review and support for OSV compliance
•Develop annual charge master
•Participate in revenue related business strategy development

Qualifications

Education & Experience:

•Bachelor's degree with focus in Business or Healthcare Administration required. MBA or MHA preferred.
•Minimum of five years' of revenue cycle management in healthcare practice management with a strong preference for a background with a FQHC or Community Based Healthcare organization.
•Superior leadership, problem solving, team building and decision-making skills.
•Experience overseeing revenue activities, managing payer contracts, organizing strategies to increase profitability, and meeting all financial objectives
•Excellent analytical ability, expertise with Excel and Word.
•Professional coding (AAPC) certification preferred. In depth knowledge of medical terminology and ICD-10/CPT coding.
•Ability to maintain confidentiality.
•Ability to handle multiple tasks and easily adapt to flexible work environment
•Revenue cycle management FQHC: 5 years (Preferred)
•Revenue cycle management in community based healthcare: 5 years (Preferred)
•Non-profit setting: 5 years (Preferred)
•Medical Practice Setting: 5 years (Preferred) or equivalent financial system.
•Excellent interpersonal skills

Competencies and Attributes:

•Unquestionable ethics and integrity, with clear understanding and adherence to ethical principles, organization values, code of conduct and policies;
•Customer service focused with the ability to handle challenging and confidential issues in a professional and timely manner;
•Familiarity with federal and state labor laws to ensure that HR practices and programs are compliant;
•Detail orientated with a positive attitude and strong work ethic;
•Ability to prioritize and manage competing priorities in a fast paced environment;
•Strong organizational, time, project management skills with proven ability to multi-task and manage complex projects;
•Excellent verbal and written communication skills with strong interpersonal skills;
•Strong interpersonal skills, including being approachable, effective listening, appropriate use of style and language for the audience and ability to work with all levels of management;
•Able to take direction and accomplish tasks with minimum supervision, maintain accuracy and meet deadlines;
•Demonstrated expertise of local, state, and federal regulations;
•Ability to maintain good humor and patience while dealing with difficult situations;
•Work well within a team environment and able to work cross-functionally with other business units to gather requirements and propose solutions;
•Ability to complete analytical and audit level review of data in Excel worksheets;
•Proficient with Microsoft Office with intermediate knowledge of Excel and PowerPoint.

Codman serves a diverse population. Applicants who have a multicultural background and/or bilingual are encouraged to apply. We offer a generous benefits package including.:

•A retirement employee-funded 403(b) plan
•Competitive Medical, and Dental
•Employer-paid Life, Accidental Death & Dismemberment and Long-Term Disability Insurance
•Generous Vacation, Holiday, Personal and Sick Time Benefits
•Flexible Spending Reimbursement Accounts (Health and Dependent Care)
•Educational Assistance and tuition reimbursement Programs
•Commuter Benefits
•Other benefits and perks

CODMAN SQUARE HEALTH CENTER MISSION, VISION, AND VALUES

Mission: To serve as a resource for improving the physical, mental, and social well-being of the community.

Vision: Codman Square Health Center is our community's first choice for comprehensive, holistic, and integrated services, and empowers individuals to lead healthy lives and build thriving communities.

Values:Patients- Our patients are the center of our care team.

Community The well-being of the individual is deeply connected to the health of the community.

Advocacy We advocate for responsive policies and resources to address health disparities and promote health equity.

Staff We are a diverse, empowered, compassionate, and prepared workforce.

Innovation We promote a culture of innovation that has measurable and sustainable impact.

Partnership We build and sustain diverse partnerships

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