Director, Revenue Integrity

Company: Acuity Search Solutions, Inc.
Location: Decatur
Posted on: January 23, 2023

Job Description:

(Only QUALIFIED Healthcare Professionals accepted) Hospital/Clinic Revenue Cycling - Director of Revenue Integrity Needed

This hospital is located in Central IL near St. Louis, MO.

For more information, Contact David Lutz at 513-206-9881 and-or email resume to: DLutz@AcuityMRI.com

Summary

The Director of Revenue Integrity is responsible for developing standards and ensuring the integrity of the integrated acute care revenue charge capture. This responsibility includes all aspects of the Charge Description Master and fee schedule formulation(s), review and maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across DMH; policies and procedures development, modification and maintenance. The Director of Revenue Integrity also is responsible for developing a charge audit-capture-reconciliation process and ensuring charges are maximized for reimbursement; provides oversight and response for governmental audits such as RAC, MIC, and Third Party Payor audits; participates in compliance related activities and denials root cause and process improvement.



Essential Functions and Job Duties

1.Ensures compliance with required governmental laws, regulations, contractual requirements, standards and practices both related to the systems charge master.


2.Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, fraud alerts, OIG advisory opinions and other relevant publications. Communicates changes to impacted leaders and provides education on such changes.


3.Develops, assesses, and adapts clear and effective charge capture process, policies and procedures, training, communications and awareness material from a revenue integrity perspective.


4.Investigates and advises on matters relating to technical billing, coding, or regulatory requirements for documenting, coding, and billing.


5.Monitors and analyzes charge capture trends.


6.Assess auditing and monitoring trends and coordinate mitigation activities when opportunities for improvement (audit variances) are identified.


7.Maintain an awareness of current laws, statutes, regulations, etc. that impact healthcare operations and physician relationships.


8.Works with leaders across the organization to identify opportunities to capture all charges efficiently.


9.Leads the effort to maintain the systems fee schedule.



Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and-or ability required.



Required Education

Bachelor's degree in nursing, business administration, finance computer science or related field.



Preferred Education

Master's degree in business, health administration or related field.



Required Experience




Knowledge of the content, structure and maintenance of the Charge master and fee schedule.
Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments.
Proficient with Microsoft applications
Excellent written and verbal communication skills
Advanced problem-solving skills
Strong analytical skills capable of synthesis of complex information
5+ years of revenue cycle management, IT management or project management experience in a complex organization.





Preferred Certification & Licensures

RN, BSN, CIC, CCS, CPC designations are highly desirable.

Certification in auditing and-or health care compliance desirable




For more information, Contact David Lutz at 513-206-9881 and-or email resume to: DLutz@AcuityMRI.com

Keywords: Acuity Search Solutions, Inc., Decatur , Director, Revenue Integrity, Executive , Decatur, Illinois