Senior Director Revenue Integrity - System

POSITION SUMMARY:

Under the general direction and guidance of the VP, Revenue Cycle, the Senior Director is responsible for developing standards and ensuring the integrity of the integrated professional and facility revenue charge capture. This includes all aspects of the Charge Description Master and fee schedule formulary(s) reviews, maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; collaboration with all service lines across the BMC Enterprise; policies and procedures development, modification, and maintenance. The Senior Director is also responsible for developing a charge audit/capture/reconciliation process and ensuring charges are maximized for reimbursement. The Sr Director also participates in compliance related activities and denial root cause analysis and process improvement, as appropriate.

The Senior Director is responsible for leading and managing complex revenue cycle projects - to include, driving performance and providing overall direction and oversight of the functional areas with Revenue Cycle that support the organization's financial and operational goals. They will ensure develop policies, procedures, and workflows related to revenue cycle functions throughout the continuum in collaboration with internal Revenue Cycle and External Departments. Fosters and promotes a culture of excellence in customer service to internal and external clients. Builds trust and collaboration amongst the team by enhancing employee engagement, addressing performance results, and providing coaching and mentoring.

The Senior Director will provide financial management, leadership, and expertise in managing all details of assigned operations and works in conjunction with other departmental leadership.

Position: Senior Director Revenue Integrity - System

Department: Revenue Cycle

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Leadership

• Collaborate with the VP Revenue Cycle in defining vision, strategy and priority setting for areas of responsibility across the BMC System, including Community Hospitals and Academic Hospital.

• Conducts audits, on a periodic basis all areas treating patients to ensure all professional and facility billable charges are captured. This review is inclusive of, but not limited to, the departmental CDM and / or fee schedule encounter forms, systems generating charges (especially any mappings in an ancillary charge systems), reconciliation processes, revenue and usage reports, CPT / HCPCS codes, ICD-9 (ICD-10) codes and revenue codes.

• Direct, set vision, and define roles and responsibilities for the Department, including training, delegating tasks, overseeing daily activities, mentoring, guiding through demonstration of best practices and offering opportunities for professional development. Ensures the highest standards for the hiring selection, training, orientation, and assignments of department staff. Provides leadership to direct reporting management staff with regards to the evaluation, promotion, resolution of employee relations/disciplinary concerns and the termination of employees.

• Develop and maintain methodologies to monitor departmental conformity to BMC standards related to charge posting, charge reconciliation and other billing related issues.

• Assess professional and facility charging and patient care documentation practices and procedures to ensure compliance with pertinent regulations and guidelines; and ensures efficient departmental operation by providing education and support.

• Oversees communication of coding and reimbursement updates published in third-party payer newsletters / bulletins and provider manuals to all staff as appropriate.

• Provide communication and coordination with all departments regarding key charge capture functions.

• Oversee the management of the consolidated professional and hospital Charge Description Master (CDM), Fee Schedules, Charge Entry & Reconciliation efforts. The CDM / charges, charge entry screens, charge entry procedures, encounter forms and supply tickets are reviewed periodically with all departments, or as otherwise defined and / or needed.

• Utilizes a proactive leadership style to model and promote a culture of trust and collaboration to provide vision and management expertise in guiding the completion of assigned projects. Where appropriate, involves staff when recommended changes or actions may impact their work functions.

• Responsible for effective identification of staffing resources, recruitment, allocation of resources, retention, recommending salary changes and corrective action/ progressive discipline.

• Holds all staff members accountable for following to regulations, BMC policies, HIPAA laws, CMS guidelines and statutes.

• Functions as highly visible, approachable, and accessible leader. Acts as catalyst to promote positive change and stimulates others to do likewise.

• Creates a motivational environment. Provides challenging assignments and opportunities for development. Effectively communicates and disseminates information to staff.

• Encourages staff to attend educational opportunities relevant to their position and supports their attendance.

• Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities. Consistently and regularly reviews payor newsletters, updates from CMS or appropriate intermediaries, meetings and communications with payor representatives, and other sources and determines relevancy to the department/practices.

• Continually seeks opportunities for improving the delivery and support of the PFC revenue cycle activities and programs.

• Assures satisfaction among customer groups with the quality and amount of support provided by monitoring and responding appropriately to outcomes and feedback.

• Actively engages in understand the job functions of staff as it relates to process flow across the practices, and other departments, e.g., Patient Access Services, credentialing, and enrollment, HIM, professional and/or hospital billing, etc.

• Ensure adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge selection / entry and documentation requirements.

• Analyze and influence appropriate action in all areas of reimbursement, by performing appropriate reviews, investigating trends and patterns, and providing education regarding charge capture and charge reconciliation.

• Ensure that controls are put in place to hold providers and hospital departments accountable for effectively managing charge capture and reconciliation processes.

OTHER DUTIES:

• Serve as a resource for department managers, physicians, and administration to obtain information and clarification on accurate and ethical billing standards, guidelines and regulatory requirements.

• Assist Patient Financial Services and FPF billing vendors with possible resolution and remediation efforts of billing edits due to charge issues, NCCI or OCE edits and medical necessity as necessary.

• Oversee research of billing and coding requirements when new procedures and / or supplies are introduced. If appropriate to bill for new services, ensures all billing systems are set up correctly, tested and monitors initial charging of services for proper billing as well as following claims for initial reimbursement.

• Monitor regulatory environment and implement appropriate workflow and process changes to support efficient, compliant, and patient-friendly departmental outcomes and results.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

REQUIRED EDUCATION AND EXPERIENCE:

• Bachelor's Degree required in Finance, Financial Management, Finance Administration, Nursing, or Information System Management, and a minimum of 8 years of experience in health care management, related field, or equivalent experience in hospital revenue cycle operations.

PREFERRED EDUCATION AND EXPERIENCE:

• Master's degree

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• None

CERTIFICATES, LICENSES, REGISTRATIONS PREFERRED:

• Coding certification in at least one of the following: CPC, CPC-P, CPC-H or Certification in Auditing and / or Healthcare Compliance. Must obtain or be working towards certification within one year of hire.

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Knowledge of various hospital and professional fee coding systems including ICD-9/10-CM, CPT and HCPCS.

• Knowledge of the content, structure and maintenance of the Charge master and fee schedule.

• Knowledge in healthcare compliance, including privacy and security regulations, confidentiality laws, access, and release of information

• Demonstrated leadership qualities and abilities with strong capabilities in change management

• Strong organizational skills with the ability to work on multiple, complex projects with high quality results

• Excellent verbal, written and attentive listening communication skills

• Strong collaborative skills to form working relationships with vendors, other departments, senior management, physicians and executives.

• Excellent analytical skills, including the ability to analyze quantitative and qualitative information and reach sound conclusions.

• Ability to perform A/R statistical analysis, identify gaps, develop and deploy solutions necessary for the achievement of key metrics (Days in A/R, aged receivable greater than 90 days, denial rate, bad debt percentage and collection rate.)

• Appreciation of timeliness with resolving issues and determining priorities. Strong planning and delegation skills, including ability to develop and cross-train staff.

• Possesses strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments.

• Strong quantitative, analytic, and problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions. Strong organizational skills to keep track of multiple priorities of highly detailed information.

• Proficient with standard Microsoft programs (i.e., MS Word, Excel, PowerPoint, Outlook) and web browsers. Advanced use of Micro Soft Excel and Access is preferred.

• Must be able to present information effectively in both written and oral forms.

Equal Opportunity Employer/Disabled/Veterans