We are recruiting for a motivated Director, Revenue Integrity to join our team!

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Department

Billing and Collections

Job Summary

Under minimal supervision, the Director of Revenue Integrity role has responsibility and accountability for developing strategies and ensuring efficient and compliant revenue processes which ensure that the organization collects all revenue to which it is entitled while maintaining compliance. Areas of responsibility include charge capture, charge reconciliation, charge maintenance CDM pricing strategy, charge edits, clinical denials, RAC audits, revenue cycle regulatory monitoring, and multidisciplinary clinical, operational, and financial revenue practice teams. This role identifies and partners with departments to reduce revenue leakage through impact studies, revenue reviews, and industry best practice.They will have experience working in a large, complex, matrix organization, and will have proven leadership experience and a demonstrated track record of leading a large health system through transformations resulting in performance improvement and training. The ability to have a significant impact on standardization and improvement of operations to align with leading practices will be critical to this role.

Essential Functions:

• Manages, coordinates, and champions multiple revenue cycle initiatives across the organization to improve processes and support optimal high-performing revenue cycle operations (15%)
• Sets strategy and oversight of Revenue Practice Teams (RPTs). RPTs are Revenue Integrity-led multidisciplinary groups that assemble a cross-functional team by designated service lines created to identify quick wins and long-term strategies by reviewing clinical documentation and revenue cycle workflows to support a clean claim. Focus areas include standardizing, optimizing, educating, payer contract payment performance, payment variance reviews, and corrective or escalation actions to reduce revenue leakage through usage and implementation of Revenue Guardian and other Epic based reports. (10%)
• Oversee the Charge Edits team areas of focus including NCCI edits reviews, intervention, and review of patient accounts requiring additional oversight, processing corrected claims and compliance audit rebills. Charge Edits team assists with denials research from internal departments and third-party agencies. (10%)
• Directs the maintenance of the CDM (Hospital and Physician Billing) by incorporating new charges/services identified by internal stakeholders, third-party resources, CMS special requirements, and coding updates. Oversees the monitoring and change management practices for the CDM, revenue routing, fee schedules, and client agreements while maintaining consistency with third-party, regulatory oversight agencies and legislative requirements. Ensures codes contained in the CDM and fee schedules are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing. Analyzes CDM and makes recommendations for improvement or reimbursement maximization. Continually evaluates CDM for lesser of charge issues. Acts as champion or business owner of external vendors that provide CDM and CDM related products. (20%)
• Participates in various IT-related steering committees for information technology changes that affect the revenue cycle. Champions design, build, and implementation of revenue-generating clinical services within Epic and other IT platforms. (5%)
• Promotes and oversees process improvement opportunities for charge capture improvement. Provides direction and oversees the charging charge methods are applied consistently and accurately at the care site and supporting areas through the appropriate owner assignment and tools. Oversees revenue optimization identification and education departments with respect to the use and maintenance of the CDM and charging philosophy. Works collaboratively with the revenue-producing department leadership and clinical care sites to ensure all charges are being documented, captured, and reconciled. (10%)
• Directs program responsible for clinical appeals related to final denials prepared by RNs. Provides executive-level Revenue Integrity-related presentations, overviews, and recommendations. Collaborates and assists in the resolution of problems causing payer denials, recoupments, and failed edits as they involve the charge capture, charge master and professional fee schedule, including clinical charging workflows. (10%)
• Oversight of the team managing the Medicare and Medicaid RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates to Compliance, Utilization Review, and Finance leadership. Partners with internal counsel and external vendors during all levels of the appeal process including settlement conferences and trials. Maintains and monitors high success rates in the audit program. (10%)
• Directs human resource functions such as interviewing, selection, orientation, education/training, feedback, performance evaluation, and policy and procedure development. Oversees the maintenance of personnel files, including documentation of appropriate staff orientation, competency, training, discipline, and performance reviews. Oversees department timekeeping and payroll. Collaborates with HR concerning employee issues and performance. Conducts employee coaching, counseling, disciplinary actions, and annual appraisals. Ensures staff adherence to hospital and departmental policies and procedures. Participates in the Talent Management program, including mentoring and providing development opportunities for leaders and identification of high potential associates to ensure effective succession planning. Identifies staff development needs of employees and ensures appropriate training is provided.Directs human resource functions such as interviewing, selection, orientation, education/training, feedback, performance evaluation, and policy and procedure development. Oversees the maintenance of personnel files, including documentation of appropriate staff orientation, competency, training, discipline, and performance reviews. Oversees department timekeeping and payroll. Collaborates with HR concerning employee issues and performance. Conducts employee coaching, counseling, disciplinary actions, and annual appraisals. Ensures staff adherence to hospital and departmental policies and procedures. Participates in the Talent Management program, including mentoring and providing development opportunities for leaders and identification of high potential associates to ensure effective succession planning. Identifies staff development needs of employees and ensures appropriate training is provided. (10%)

Education:

• Bachelor's Degree A Bachelor's degree in health care administration, finance, health information management, business or clinical degree (RN, pharmacist), or related field is required. Required

Work Experience:

• 10+ years progressive responsibility in healthcare with at least Ten (10) years of increasing executive-level responsibility for multispecialty departments and multiple locations managing complex revenue cycle operations. Masters Degree could satisfy 2 years of experience requirement. Required

Licenses:

Knowledge, Skills and Abilities:

• Strong communication skills.
• Ability to communicate clearly and with sensitivity.
• Ability to delegate responsibility and authority to staff.
• Ability to work creatively with management and department staff to achieve objectives.
• Knowledge of management practices to direct assigned staff.
• Skill in exercising initiative, judgment, discretion and decision-making to achieve organizational objectives.
• Skill in establishing and maintaining effective working relationships with all staff. S
• Skill in identifying and resolving problems.
• Knowledge of financial and budgetary practices to develop annual budget, analyze financial data and patterns, and prepare forecasting models.
• Highly prefer prior coding (HIM or Pro fee/Physician coding) experience, along with Charge Capture knowledge.
• Candidate must have extensive revenue cycle experience with advanced knowledge of revenue cycle, state and federal requirements (i.e., charging, billing, price transparency), and a thorough understanding of the front, middle, and back-end revenue cycle practices.
• Healthcare Compliance Certification from HCCA is preferred
• Nursing or Clinical Care Experience is highly preferred
• Extensive knowledge in the field of revenue integrity practices and requires a clear and creative individual that ensures the methodologies employed sustain cash flow for the system while adhering to compliance with payer and regulatory regulations required to serve as subject matter expert.
• Ability to build strong partnerships across the organization with Managed Care, Finance, ITDS, operations and clinical leadership to ensure strategies are executed while keeping the patient clinical and financial record aligned.
• Understanding of coding classification systems, such as ICD-10-CM, ICD-9-CM, MS-DRG, CPT-4, APR-DRG, and HCC strongly preferred
• Extensive knowledge of facilitating engagement-related strategies to create high-performing teams, and a work culture aligned with the system's mission, vision, and values.
• Competency in developing efficient and effective solutions to complex business challenges
• Ability to influence key stakeholders at various organizational levels
• Excellent interpersonal, organizational, presentation, verbal, and written communication skills.
• Regular attendance to perform work on-site during regularly scheduled business hours or scheduled shifts is required

Shift

Days (United States of America)

Work Type

Regular

Salary

$129,635.00 - $200,376.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denvers 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorados primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit: https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion

Applicants will be considered until the position is filled.

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