Position Overview:

As the Director of Revenue Integrity, you will spearhead the strategic direction and operational oversight of our revenue cycle. Your primary focus will be to ensure the financial health of our patient and third-party receivables, working collaboratively with clinical leadership to optimize the patient financial journey throughout their care. Your expertise will be instrumental in maximizing revenue generation to support our organizational mission and drive high performance.

Key Responsibilities:

• Maintains the health center's fee schedule by incorporating new charges/services, third party changes, CMS special requirements and coding updates.
• Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional billing office.
• Works collaboratively with the revenue producing department staff to ensure all charges are being captured and documented.
• Fosters partnering relationships with the Compliance Office and other third parties to ensure the accuracy of fee schedules.
• Oversee efforts to ensure timely response and compliance with regulatory agencies.
• Educates health center departments on the organization’s charging philosophy.
• Ensures timely review of regulatory literature such as Colorado Medicaid bulletins, the Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting our charge capture systems.
• Coordinate with other departments to ensure that the codes contained in the professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
• Ensures the on-going accuracy and integrity of the professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments to implement necessary changes to charge documents, charge capture process, and order entry procedures.
• Identifies services that are reimbursable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes and sets rate.
• Determines charge and charge attributes for new services and products and responsible for developing and maintaining a rate setting policy.
• Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the professional fee schedule.
• Works collaboratively with the revenue producing staff to ensure all charges are being captured and documented.
• Facilitates positive communication and builds strong relationships between Revenue Cycle staff and other departmental staff and payors regarding revenue cycle matters.
• Establishes revenue cycle reporting requirements to meet the needs and expectations of all organizational leadership and ensures timely reporting of revenue cycle performance through collaboration with appropriate information sources.
• Ensures that payor contract performance is monitored.
• Participate in various information technology changes which affect the revenue cycle and lead planning initiatives for revenue cycle IT related enhancements.
• Establishes performance goals and expectations relevant to the revenue cycle. Prepares annual objectives, plan of action and budgets, as appropriate. Monitors benchmark data related to revenue cycle performance.
• Plans and schedules annual audit of selected health center departments; compares medical records against claim to ensure optimum and appropriate charge capture and coding accuracy.
• Manages and monitors the performance of external vendors.
• Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
• Participates in the creation of written Revenue Cycle guidelines, policies and standard operating procedures and ensures consistent company-wide implementation, as appropriate.
• Ensures that policy development of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State and payer regulations, guidelines and requirements.
• Perform other duties as assigned.

Education and Experience:

• Bachelor’s degree in business or related field, preferred. Experience in lieu of degree allowed.
• Three years’ billing and supervisory experience required. Project management and/or planning preferred. Experience with Federally Qualified Health Centers is a plus. Knowledge of government, commercial and discount billing required educational requirements, include options for substitutions where allowed
• Certified Coder, preferred, or ability to become certified within 18 months of hire

Skills and Expertise

• Ability to interact positively and build rapport with patients, coworkers and/or external contacts.
• Ability to work independently and organize work in a manner that ensures accuracy and efficiency.
• Knowledge of revenue cycle and financial progressions.
• Understands and remains updated with current coding and charge regulations and compliance requirements.
• Ability to demonstrate the capability to effectively and sensitively respond to the needs and concerns of the full range of patients and staff.
• Customer service skills, including the ability to resolve conflict efficiently and effectively.
• Basic math skills required, understanding of accounting helpful.
• Skill in using a variety of computer software including but not limited to the internet and MS Office products.
• Ability to handle sensitive information ethically and responsibly aligning behavior with the standards and values of the organization.
• Ability to protect the confidentiality of patient, employee and business information.
• Must be experienced in working in a fast-paced environment and be able to multi-task and prioritize.
• Billing and revenue cycle knowledge within Epic
• Employee demonstrates knowledge of and adherence to the Compliance Plan and conflict of interest requirements. The employee enhances the effectiveness, efficiency and productivity of the department by contributing to, and participating in, departmental performance improvement goals
• Support the organization’s Mission and Vision and model behaviors that exemplify our Core Values of Integrity, Compassion, Accountability, Respect, and Excellence.

Required Tools of the Job

• Computer, Microsoft Office products, Electronic Medical Records system and internet.
• Copier, printer, scanner, fax machine and calculator.
• Multi-line telephone.
• Video and telephone conference equipment.
• Other office equipment as needed.

We offer a competitive salary range of $144,000 - $173,000, depending on your experience.

The final salary for the selected candidate will be determined based on several factors, including experience, education, budget, internal equity, specialty, and training.

Benefits:

Join us for a fulfilling career with a comprehensive full-time benefits package that promotes professional growth, well-being, and financial security, including:

• Medical, dental, and vision coverage
• Paid time off (PTO) and holidays
• Health Savings Account (HSA) and Flexible Spending Account (FSA), including dependent care options
• 401(k) with matching
• Work-life balance
• NHSC Loan Repayment
• Tuition reimbursement and/or Continuing Medical Education (CME)
• No nights, weekends, or major holidays
• Employee Assistance Program (EAP)
• Employee Discounts on top attractions, hotels, more