Director, Revenue Integrity

Revenue Integrity Director

As the lead of the Revenue Integrity team, the Revenue Integrity Director defines and carries out the strategy for maximizing gross and net revenue capture across the enterprise. The Director serves as the chief liaison between Revenue Cycle and clinical departments. The Director also ensures the availability and interpretation of reporting and analytics necessary for the clinical and Revenue Cycle departments to drive financial improvement.

Within the Revenue Integrity department, the Director oversees the following functions: charge capture, revenue reconciliation, Charge Description Master (CDM) and Charge Generation Tracker (CGT) maintenance, strategic pricing, contract management, payment validation, denial management and avoidable write-off prevention, and reporting and analytics. They also serve as the ultimate escalation point for both the gross and net revenue streams. While HIM/Coding is not formally under the supervision of the Revenue Integrity Director, it will be the Director's job to collaborate with the directors of HIM/Coding and ensure teamwork and knowledge share across teams to avoid any duplicative or conflicting efforts. The Director will report directly to the VP of Revenue Cycle.

Essential Job Functions

• Lead the Revenue Integrity Department in an efficient and compliant manner. Oversee monitoring and improvement efforts within the functional areas of Revenue Integrity, including:
• Charge Capture - Ensure appropriate audit activities take place prior to and after billing to ensure accurate and optimal revenue capture and seek to continually improve charging processes within departments.
• Revenue Reconciliation - Provide oversight of Revenue Reconciliation completed by operational and clinical leads across the enterprise, including the use of appropriate tools to support revenue and charging reconciliation.
• CDM/CGT Management - Ensure the CDM/CGT is maintained, new codes are entered timely, and any pre-bill edits are worked timely.
• Strategic Pricing - Provide oversight for annual price increases across the organization. Understand pricing goals and net impact of associated price increases.
• Contract Management - Oversee updates on performance, including risks to payor compliance with agreed-to contract terms, and current process improvement initiatives.
• Payment Validation - Ensure accurate reimbursement by payors through internal processes and tertiary processes.
• Denial Management and Avoidable Write-Off Prevention - Utilize data analytics to identify trends and work with functional areas for future prevention.
• Reporting and Analytics - Provide objective analysis through advanced reporting and interpretation of findings to support Revenue Integrity processes.

Essential Job Duties

• Oversee all functions performed by the Revenue Integrity team, including analytics and reporting, communication with departments and external stakeholders, and ongoing strategy and development of the program.
• Work with the Revenue Integrity team to develop meaningful metrics and key performance indicators to drive strategic analysis and decision-making.
• Lead targeted revenue improvement opportunities and assist with analyzing the financial impact as related to professional and hospital clinical departments.
• Work proactively with leadership within Revenue Cycle and Finance to prioritize areas of focus and ensure appropriate ongoing performance.
• Assist in the development and maintenance of appropriate controls and security of processes that lead to accurate clinical, operational, and financial operations.
• Act as liaison between HIM/Coding and Revenue Integrity to foster collaboration and ensure coordination of efforts between the teams, as appropriate.
• Uphold enterprise mission, vision, values, and ethical standards and demonstrate the behavioral and service expectations as defined in our policies and procedures.

Minimum Requirements

• Bachelor's Degree in Business Administration, Health Care Administration, Clinical Administration, Finance, or related field required.
• Master's Degree preferred.
• Eight years of hospital Revenue Cycle, Revenue Integrity, and/or reimbursement experience are required, including seven years management experience, with emphasis on project management.
• Knowledge of Revenue Cycle processes, medical billing and coding processes, detailed accounting principles, quantitative decision making, and process analysis.
• Strong interpersonal skills, critical thinking skills, and the ability to communicate effectively to secure clinical and non-clinical information required for technical and operational revenue updates.
• Ability to work independently and take initiative across multiple workstreams.
• Skill in time management and project management, and multi-tasking is a must for this position.
• Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
• Advanced level of communication, problem solving, and organizational skills to maintain a high level of production and accuracy in an extremely task driven environment.
• Demonstrated expertise using Excel, PowerPoint, and Word.
• Ability to express ideas and communicate professionally, effectively, verbally and in writing, and to train others on technical matters. Ability to manage multiple staff members while maintaining a high level of production efficiently and effectively throughout the entire team.
• Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
• Advanced skills in problem solving in a variety of settings and translation of data into actionable steps.
• Knowledge of insurance claim processing and third-party reimbursement.
• Knowledge of state and federal regulations as they pertain to billing processes and procedures.
• Knowledge of various types of provider reimbursement methodologies including per diems, inpatient DRG/APRDRG case rates, percent of charges, and outpatient surgery case rate methodologies such as ASC and OPPS as established by CMS.
• Ability to willingly accept responsibility and/or delegate responsibility.

Pay Range $129750.40 - $189114.64

• Hybrid role (based out of Greenville, NC)
• Monday - Friday day shift
• Great Benefits

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children¿s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification. We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.