Associate Director Revenue Integrity

About This Role

This role involves providing operational oversight to the Revenue Integrity Analyst team, focusing on revenue optimization through charge capture reconciliation, review initiatives, education, and process enhancement. The Associate Director ensures compliance with CMS and other regulatory agencies while mentoring team members and troubleshooting issues.

Responsibilities

• Provide operational oversight of the Revenue Integrity Analyst team
• Monitor and trend financial data related to charge capture progress toward revenue cycle goals, identify variances, and implement process improvements
• Serve as a liaison between Revenue Integrity and clinical/operational departments to escalate charge issues and inquiries to key stakeholders
• Develop, educate, and manage Revenue Integrity Specialists, supporting them in analyzing and communicating deficient charging trends and corrective action plans
• Engage with clinical areas and revenue cycle departments across Banner to confirm billable items and services are charged appropriately
• Provide revenue integrity recommendations and updates to the Revenue Integrity Steering Committee
• Maintain current knowledge of regulatory changes impacting charge practices and develop charge capture and reconciliation policy and procedures
• Implement charge capture review program for hospital revenue generating departments
• Manage charge reviews to ensure annual coding changes/new service lines are incorporated into the charge master and flow correctly to the patient bill
• Work independently and make independent judgments based on specialized knowledge

Requirements

• Bachelors degree in business, healthcare administration or equivalent work experience
• 5+ years recent experience in Revenue Integrity
• At least 2 years of experience within leadership role, including performance management of direct reports
• Proficiency with 5+ years of health care coding and billing experience
• Thorough knowledge of ICD/DRG coding and/or CPT coding principles
• In-depth knowledge of medical terminology, anatomy and physiology
• Thorough understanding of the content of the clinical record
• Extensive knowledge of all coding conventions and reimbursement guidelines, across all services lines, LCD/NCDs and MAC/FIs
• Extensive critical and analytical thinking skills
• Excellent written and oral communication skills
• Effective human relations and leadership skills

Qualifications

• Bachelors degree in business, healthcare administration or equivalent
• 5+ years recent experience in Revenue Integrity; 2+ years of experience within a leadership role including performance management of direct reports; 5+ years of health care coding and billing experience

Nice to Have

• Additional related education and/or experience

Benefits

Certifications