Careers

Director of Revenue Integrity

Job ID: 10633

Date posted: 3/23/2020

  • Department: Fiscal Administration
  • Schedule: Full Time
  • Shift: Days
  • Hours: 830am-500pm
  • Location: Tufts Medical Center

Job Details:

Reporting directly to the Vice President of Revenue Cycle, the Revenue Integrity Director is responsible for overseeing the revenue integrity activities for Tufts Medical Center, the Physician Organization and Floating Hospital for Children. This position will direct and lead Activities to drive compliant net revenue capture through accurate and complete capture of charges, implementation and maintenance of charge structure and charge master and education of clinical operations leaders as to their roles and responsibilities for charge capture.  The Director will manage the overall business planning, budgeting, and evaluation of the Revenue Integrity Department's services and performance.   

Responsibilities;

  • Directs daily activities of revenue integrity areas for all hospital and physician organization billing, providing direction regarding the department’s priorities and standards
  • Directs the development, implementation, and maintenance of revenue integrity policies and procedures.
  • Ensures compliance with all government regulations. Promotes compliance with established departmental policies for attendance, punctuality, procedures and safety.  Complies with organizational policies and procedures.
  • Ensures the identification of revenue cycle infrastructure and operational issues, as they relate to workflow processes, charge entry, and coding across high-volume and/or high revenue-generating clinical departments, as well as the identification of any corresponding bottlenecks, charge lag delays, denials, backlogs, and rework activities.
  • Ensures the research/analysis of data to resolve operational issues, identify and select alternatives to address outstanding issues, and implement solutions for improvement.
  • Ensures the collaboration of the Revenue Integrity team with data analysts, physicians, and leadership to educate and train providers and staff about appropriate charge capture, coding, and documentation.
  • Ensures proper oversight and management of changes/updates to the charge description master to maximize reimbursement – at least annually, timed with the Medicare coding update release, as well as on-demand in the case of regulatory changes or compliance findings.
  • Establishes and maintains a clear feedback loop and communication structure across CDM stakeholders (e.g., clinical departments, Patient Financial Services) to promote transparency and accountability.
  • Ensures the review and recommendation of changes, as appropriate, to department organizational structure, charge capture methods, and tools to facilitate accurate and comprehensive billing and compliance.
  • Ensures all clinical activity is being captured, coded, and recorded timely in the appropriate financial application(s).
  • Ensures appropriate management and coordination of government, payer, and internal audits.
  • Ensures the planning and completion of complex studies and audits to improve operational and financial effectiveness of the health system.
  • Facilitates the completion of detailed audits of inpatient and/or outpatient medical accounts, assessing the accuracy of documentation to support claims/reimbursement, as well as the reporting of charge errors, as appropriate, to patient financial services, payers, and patients.
  • Oversees enterprise charge capture processes, productivity of auditors, prospective/retrospective clinical documentation audits to support billing/reimbursement, education/training, and monitoring of clinical department charge capture functions.
  • Facilitates identification of issues and trends leading to claim denials and avoidable write-offs.
  • Ensures the research and analysis of accounts to determine the root cause of those issues.
  • Facilitates initiation of action plans for identified denial issues, payment delays, and avoidable write-offs.
  • Prioritizes the resolution of denials/write-offs trends that most affect cash collections.
  • Leverages cross-departmental communication, collaboration, and engagement in order to resolve denials/write-offs issues, and facilitates the execution of action plans to address process breakdowns.
  • Ensures each department reviews their population of denials/write-offs root cause categories on a monthly basis and completes any assigned action items that arise.
  • Ensures the coordination of revenue management orientation and educational activities of clinical personnel – including providers and staff – about coding and other outstanding revenue cycle issues.
  • Develops and enforces productivity standards and performance goals, and monitors department’s performance.
  • Maintains regular contact with staff to keep abreast of issues and to provide feedback on overall operations and specific issues.
  • Assumes responsibility for professional growth and development of all Revenue Integrity staff.
  • Prepares annual departmental budget and is accountable for departmental monthly expenses and budget compliance.
  • Interacts with Business Office Director, HIM Director, Case Management, Physicians and Office Staff, Department Directors, Patients and Patients’ Family, and Administration.

Qualifications;

  • Bachelor's degree with 7-10 years of progressive management experience in healthcare revenue cycle environment required.  Master's degree preferred.
  • Must possess strong management skills and ability to make decisions, directing, delegating and supervising staff.
  • Excellent organizational, interpersonal and leadership skills.
  • Excellent negotiation and problem-solving skills.
  • Excellent verbal and written communication skills; ability to effectively communicate with physicians, patients, staff, payers, and executives.
  • Ability to investigate analyze and resolve issues at a high level; work efficiently and accurately; and organize and plan work.
  • Flexibility to work additional hours and ability to work under stress.
  • Ability to work effectively with individuals of all cultures and levels of authority.
  • Working knowledge of SMS/Invision preferred.
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