Dir- System Revenue Integrity

Reporting to the Vice President Revenue Cycle, the Director, Revenue Integrity is responsible for providing system oversight of charge capture and revenue reporting. This leader partners with Clinical Operations, Revenue Cycle and Finance to ensure integrity of processes related to charge capture and reconciliation, charge description master (CDM) design and management, and revenue reporting of charges and relative value units (RVUs).

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Responsible for the team that monitors charge activity including comparison of actual and expected charges and investigates variances. Manages revenue analysis follow-up and remediation process. Holds Business owners accountable for results and reports to senior leadership.
• Monitors the regulatory environment related to charging practices and ensures appropriate communication and process design responses.
• Works closely with clinical leaders across the system to identify new products and services or changes to the delivery model for existing services to ensure that the charge description master (CDM) and technology and processes are appropriate.
• Performs annual risk assessment identifying high impact areas for review. Develops annual revenue integrity assessment plan based on results of risk assessment. Monitors the quality of output and customer satisfaction related to Revenue Integrity Assessment process.
• Manages the priority and sequencing of revenue improvement initiatives. Sets system-wide charge capture policies and procedures, holds business owners accountable for results and reports out to senior leadership.
• Ensures that charge reconciliation processes are executed properly across the health system.
• Works closely with clinical leadership and Finance to ensure that revenue is routing to appropriate departments.
• Responsible for supervising the delivery of appropriate education and feedback to providers and ancillary staff related to revenue integrity.
• Leads monthly revenue integrity steering committee meetings to follow-up on negative/positive trends, prioritize opportunities for system implementation and track progress of improvements initiatives.
• Ensures the on-going accuracy and integrity of the CDM and corresponding technology by leading the CDM team in identification and implementation of CDM content and structure improvement opportunities, collaborating with revenue cycle and clinical operations stakeholders to promote positive outcomes.