Associate Director Revenue Integrity

About This Role

Provide operational oversight for the Revenue Integrity Analyst team, focusing on revenue optimization through charge capture reconciliation, review initiatives, education, and process adherence to ensure compliance with CMS and other regulatory agencies.

Responsibilities

• Monitor and trend financial data for charge capture progress towards revenue cycle goals, identifying variances and implementing process improvement to enhance compliant revenue optimization.
• Provide operational oversight of revenue integrity staff and serve as a liaison between Revenue Integrity and clinical/operational departments to escalate charge issues and inquiries.
• Develop, educate, and manage Revenue Integrity Specialists, supporting them in analyzing, communicating, and educating hospital and clinics regarding 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 and in a timely manner.
• Provide revenue integrity recommendations and updates to the Revenue Integrity Steering Committee with potential actions for remediation.
• 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 incorporated into charge master flow correctly to the patient bill.
• Work independently under limited supervision, making independent judgments based on specialized knowledge.
• Hold system-wide responsibility for managing the company’s charge capture, charge reconciliation, and chart reviews related to charging issues.

Requirements

• Strong knowledge of business and/or healthcare
• 5+ years of healthcare coding and billing experience
• Thorough knowledge of ICD/DRG coding and/or CPT coding principles
• In-depth knowledge of medical terminology, anatomy, and physiology
• Understanding of content of clinical record and extensive knowledge of all coding conventions and reimbursement guidelines
• Extensive critical and analytical thinking skills
• Ability to organize workload to meet deadlines and maintain confidentiality
• Ability to research, interpret, and develop recommendations
• Excellent written and oral communication skills
• Effective human relations and leadership skills

Qualifications

• Bachelor’s degree in business, healthcare administration or equivalent work experience
• 5+ years of recent experience in Revenue Integrity; at least 2 years of experience within a leadership role, including performance management of direct reports.

Nice to Have

• Additional related education and/or experience

Skills

* Required skills

Benefits

Certifications