Director, Revenue Integrity

Senior Director Of Revenue Integrity

The Senior Director of Revenue Integrity leads the identification and resolution of payer variances and sets the strategic direction for assigned Revenue Integrity functions across Enterprise Service Delivery in the United States and India.

Essential Functions and Tasks

• Partner with Payer Contracting to address situations in which payers are not reimbursing clients according to contracted rates.
• Communicate underpayment findings and their financial impact, including both volume and value, to Client Success leaders so information can be shared effectively with clients.
• Build and maintain relationships with payers to resolve contract variances and support bulk appeals.
• Lead the day-to-day operations of Revenue Integrity, focusing on mitigating contracted underpayments and analyzing payer trends, workflows, productivity, and quality to maximize client cash recovery.
• Implement and optimize best practices, policies, and standardized workflows through continuous improvement initiatives.
• Identify automation opportunities to reduce manual touchpoints and improve efficiency.
• Monitor the overall health of Revenue Integrity operations and develop action plans to address underpayments through data analysis and effective inventory management.
• Use data and analysis to proactively identify trends and prepare executive summaries for leadership and Client Success teams.
• Foster strong interdepartmental relationships through collaborative communication, leadership, and end-to-end problem solving.
• Oversee U.S. and India Enterprise Service Delivery relationships, productivity goals, and performance, and address gaps through appropriate remediation.
• Work closely with Enterprise Service Delivery teams, Business Unit Presidents, and Client Success leaders to understand and meet client expectations.
• Represent Revenue Integrity in presentations to payers, the Ventra executive team, and clients.
• Provide direction and oversight for operational training for new and existing Revenue Integrity staff.
• Maintain confidentiality of personal, financial, and medical information in accordance with HIPAA guidelines and Ventra Health policy.
• Perform special projects and other duties as assigned.

Education and Experience Requirements

• Bachelor's Degree in Business/Healthcare Administration or equivalent training or experience considered
• At least seven (7) years AR Management/Contract Management experience in the areas of Emergency Med, Hospital Med, Radiology/Interventional Radiology, or Anesthesia/pain management preferred
• At least four (4) years of leadership experience required
• Global service delivery experience required

Knowledge, Skills, and Abilities

• Knowledge of State, Federal, and Managed Care regulatory guidelines
• Knowledge of benefit insurance billing and contract management
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
• Strong oral, written, and interpersonal communication skills
• Strong decision-making skills
• Strong problem-solving skills
• Strong time management skills
• Basic word processing, spreadsheet, database, and presentation software skills
• Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals
• Ability to read, understand, and apply state/federal laws, regulations, and policies
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
• Ability to remain flexible and work within a collaborative and fast paced environment
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Become proficient in the use of billing software within 4 weeks and maintain proficiency.
• Understand and comply with company policies and procedures.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at View email address on click.appcast.io to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on

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