Job Details

Overview

Director, System Revenue Integrity (Revenue Cycle Operations) Cape Cod Healthcare

PurPose of position: Develops and executes the strategic vision for system-wide Hospital, Professional and Ancillary Services Revenue Integrity functions within Cape Cod Healthcares Revenue Cycle organization. Provides leadership and oversight of key operational and financial decisions pertaining to all underlying functions. Functional areas reporting to this position include CDM maintenance, charge capture and reconciliation related functions, payment variance, audit and appeals management, and denials management processes. Defines efforts to address denial root cause issues and ensures metrics, charge entry rates, and accuracy rates meet yearly revenue goals.

Primary Duties and Responsibilities

• Lead the establishment and implementation of KPIs for revenue integrity functions; ensure action plans when performance is not meeting expectations; review KPI expectations annually; recognize areas of excellence.


• Develop, implement, and oversee operational policies, processes, tools, and educational materials within all Revenue Integrity functional areas.


• Oversee a system-wide Charge Review program to identify charge capture issues and improvement opportunities to minimize revenue leakage through technology enablers and proactive internal audits.


• Ensure the CDM is compliant with regulatory and payer requirements and that services have an established charging and reconciliation methodology.


• Ensure Revenue Integrity employees comply with policies, processes, and QA programs.


• Identify process improvements in charge capture and lead design/implementation.


• Monitor SLAs between Revenue Integrity and related functions; manage charge review queues/requests appropriately.


• Build relationships with Revenue Cycle stakeholders and core support departments.


• Develop and manage policies, procedures, processes and performance monitoring across all revenue integrity functions.


• Ensure audits of denial management are performed and coordinate with peers to identify trends and implement denial prevention/recovery programs.


• Oversee, measure, and report financial and operational performance of Revenue Integrity and denial management.


• Support strategic initiatives requiring revenue integrity involvement.


• Assess direct reports performance and provide feedback for improvement.


• Lead KPI establishment for audit and appeals; implement action plans and review KPI expectations annually.


• Develop reporting to support transparency of audit and appeals outcomes; identify and implement improvements in audit/appeals workflows.


• Develop and monitor productivity metrics for all Revenue Integrity areas; oversee payment variance teams and workflows.


• Address system or payer-related issues causing payment variances; develop reporting to identify root causes; report variances to executive leadership.


• Promote continuous improvement and CCHC Pillars of Excellence.

Education/Experience/Training

• Bachelor's degree in Business Administration, Healthcare Management or related discipline, or equivalent experience.


• Minimum five to seven years of relevant experience in a complex healthcare organization; three to five years of supervisory/management experience.


• Strong knowledge of billing/collection processes, charging processes, and revenue cycle management.


• Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity.


• Strong analytical, organizational, and process optimization skills; ability to synthesize data and develop solutions.


• Effective communication and presentation skills; ability to influence within a corporate environment.


• Understanding of interdepartmental relationships across hospital departments.


• Excellent leadership, delegation, and interpersonal skills.

Seniority level

• Director

Employment type

• Full-time

Job function

• Management

Industries

• Hospitals and Health Care

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