This position will have a specific focus on revenue integrity teams with the goal to enhance effectiveness of patient net revenue realization and minimize revenue leakage across the system. This involves complete capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations. In addition, the Director of Revenue Integrity will have a firm understanding of the Medicare IPPS, OPPS and ASC payment system.
Missing charges, Pre-bill Edits, Rejections and Denials: Oversees and provides direction to coordinators, extended team, special projects analysts, and consultants as necessary to support Revenue Integrity functions.
Charge Description Master: Oversees the development, implementation and maintenance of the standard system charge description master (CDM) in accordance with policies and procedures.
Pricing (CDM and physician fee schedules): Management and accountability for fee schedule and CDM prices. Research, analyze, and recommend fee structure and derivation methodologies for the Senior Leadership Team to support.
Supervisory and Leadership Responsibility: Develops and oversees strategic vision and on-going enhancement of the Department through planning and execution.
Basic Qualifications: (Required)
Minimum five (5) years of experience with facility and professional services billing, edit, rejections charge capture and CDM experience, (regulatory compliance, billing rules and regulations, maintenance, auditing, internal controls, and pricing).
Bachelor's degree in health care financial management, business or related field OR four (4) years of experience in a directly related field
High School Diploma or General Education Development (GED) required
License, Certification, Registration
Minimum ten (10) years of experience with facility and professional services billing, charge capture and CDM experience, (regulatory compliance, billing rules and regulations, maintenance, auditing, internal controls, and pricing)
Minimum five (5) years of experience as a CDM/Charge Capture Director in a large hospital system
Leadership experience with patient billing and accounts receivable reduction practices
Experience with Medicare billing regulations with a strong understanding of compliance requirements
Master's degree in health care finance, business or related field
Registered coder (CPC or CCS)
Professional affiliation with the American Health Information Management Association (AHIMA), the Professional Association of Healthcare Coding Specialists (PAHCS) or AAPC
Leadership position in an integrated health system
Significant systems expertise with Epic
Conditions of Employment:
Baptist Memorial Health Care Corporation Director of Revenue Integrity manages a significant volume of business and operations across multiple locations. Work priorities shift in response to fluctuating demands. Full time schedules are assumed to be at least 40 hours, however, incumbents are expected to remain flexible to accommodate the unit's goals and mission, and to work beyond their normal schedule when necessary. While this role will primarily be based in an office environment, there will be exposure to clinical areas and operations. Ability to provide transportation to travel as required to accomplish the goals of the unit.