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Director Revenue Integrity-Professional Billing

Job Summary

The Revenue Integrity (RI) Director is responsible for coordinating all Revenue Cycle-related efforts across the RCM, Operations, ITS, and Training Teams at THPG. This position includes regular oversite of strategic vendor relationships, key performance indicators, and enhancement of critical functions impacting RCM. This role requires in-depth understanding of Revenue Cycle metrics, basic understanding of the EMR system including but not limited to: Epic workqueue (WQ) structure and owner accountability, reporting and dashboard design, workflow barriers, and integration with external platforms (e.g., Clearinghouse). Responsibilities of the Director position will require regular collaboration across all channels.

Work Location : Remote work is a possibility, but this position will require onsite/meetings throughout the year.

Approved remote work States:

AR

FL

GA

MO

NC

OK

TN

TX

UT

VA

Job Duties

PEOPLE:

Primary responsibility to oversee and facilitate Revenue Cycle function(s) at THPG. This position will also collaborate closely with other leaders to facilitate process improvement initiatives: utilize data and observations to implement initiatives across revenue cycle operations (charge, coding, denials, etc.) to improve performance and drive additional revenue.

Conducts and/or participates in departmental and multidisciplinary meetings across organizational teams (including, but not limited to: Training Team, ITS, RCM Team, Managed Care Team, and Optum vendor).

Establishes and leads appropriate recurring and ad hoc meetings to support optimization projects, helps create strategic agendas, facilitates meeting discussion topics, and may record meeting minutes.

Leads Weekly Revenue Cycle Meeting as a central forum for targeted RCM issue identification, evaluation, and prioritization of risks and resolution plans associated with RCM processes.

Manages meeting attendance, accountability, and ensures timely resolution of issues and next steps.

Serves as RCM representation within key organization meetings (e.g., Service Line meeting, Weekly VP meeting, Denials Committee meeting).

Assists in resolution of patient, employee, and other customer concerns or occurrences' and escalates issues as needed.

Follows established communication guidelines for opportunity or issue escalation both from employees/clinics (upward) and from leadership to end users (downward).

Follows up on all communication accurately and timely.

Consistently seeks opportunities to coordinate with internal THPG departments, services, and staff to streamline workflows to improve process and enhance efficiency.

Serves as central point person for communication to Operations about all revenue-cycle related items (i.e., large scale issues, training/system enhancements, new across-the-board workflows, etc.).

Serves as liaison between HB, THPG Operations, Integration and Training Team, THPG PAS resources, Optum, ITS, and clinics to make sure all process changes or updates have been vetted through applicable parties before being finalized and communicated.

QUALITY:

Oversight responsibility for outsourced vendor relationship which includes identifying issues, developing solutions to improve, and accountability for performance.

Responsible for identifying, coordinating, and overseeing the design and implementation of system and entity policies related to RCM.

Ensures timely resolution of Event Reporting Tool and patient complaints.

Collaborates with clinic-facing teams including Optum OP team, Practice Support Specialist, and Practice Managers (PMs) to ensure best practice workflows are upheld.

Collaborates with appropriate THR and THPG VP leaders to ensure process and performance is aligned with KPI’s.

Addresses issues timely regarding processes that negatively impact the Revenue Cycle.

Responsible for working with Integration and Training Team on the maintenance and creation of RCM related policies and procedures.

Owns Revenue Cycle issues log and progress tracking; facilitates monthly review of Issues Log in weekly Revenue Cycle meeting, coordinates communication to obtain account examples for root-cause research, ensures timely resolution of issues with appropriate task owners, and holds stakeholders accountable to resolution timelines.

Informs RCM members and applicable operational leadership about significant changes and developments.

Utilizes metrics and national benchmarks to drive improved performance related to all RMC functions.

Oversee fee schedule maintenance and interact with contracting: manage fee schedule pricing and change management. Provide direction to assess professional charging, patient care documentation and conduct monthly audits to provide targeted education.

SERVICE:

Primary responsibility to coordinate and oversee the improvement and maintenance of Revenue Cycle function(s) for Operations.

Works with clinical leadership to improve overall customer service outcomes and insure a positive patient journey.

Collaborates with Consumer Satisfaction leaders and projects to mitigate customer complaints.

Responsive to internal and external customer service needs and requests.

Answers timely with email responses and inquiries from clinical departments, Patient Access leaders, THR Corporate, THPG Training Team, Operations, Optum, and ITS staff.

FINANCIAL:

Ensures clinics adhere to best practice RCM workflows and maintain accurate and timely financial reporting on patient revenue.

Updates and supports Integration and Training Team with managing best-practice tip sheets, guidelines, and policies.

Monitors overall RCM metrics and escalates any issues to appropriate stakeholders (operating or training).

Reviews metric trending to identify gaps that may require training or additional support/review.

Creates, engages in, and/or leads appropriate meeting forums to track revenue goals and preventative loss strategies relating to RCM activities (collections, denials, AWOs).

Holds Operations leadership and clinic performance accountable to industry average and best-practice RCM benchmarks for optimal financial performance.

GROWTH:

Manages RCM processes and reviews any leadership/structural changes as necessary (i.e., new positions, role/responsibility shifts across Operational leadership structure).

Supports and oversees structural, operational, and/or technical changes focused on standardization and/or consolidation of RCM departments or activities; maintains long-term workplan for such projects to serve as foundation for THPG clinic process flexibility and future growth.

Education

Associate's Degree in Business Administration, Finance or other healthcare related degree required. Or, Bachelor's Degree Business Administration, Finance or other healthcare related degree or Master’s degree preferred

Experience

10 years recent experience in Healthcare Finance, Revenue Cycle Management or Practice Operations/Management required

Licenses and Certifications

Dual Hospital and Professional Coding Certification(s) (CPC, CPC-H, CCS, CCSP) preferred upon hire

Applicable clinical or professional certifications/licenses such as RN, RT, MT, RPH preferred upon hire

Skills

Strong managerial , leadership and interpersonal skills; demonstrated strong oral and written communication skills; Demonstrated problem solving and critical thinking skills with the ability to troubleshoot and resolve issues; knowledgeable in compiling statistical data; excellent computer skills; including proficiency in MS Word, Excel, Access and PowerPoint; ability to build, lead and motivate teams to successful outcomes;

Ability to review, analyze and interpret Revenue Cycle metrics, key performance indicators, billing guidelines, including state and federal regulations; solid understanding of multiple reimbursement systems including IPPS, OPPS, and fee schedule; working knowledge of multiple healthcare applications, including but not limited to Epic, GE Centricity (flowcast), Mosaiq, Allscripts, and Revenue Cycle bolt on reporting tools; knowledgeable of accurate sources for updating all applicable code sets (CPT/HCPCS/ ICD-9, etc.) inclusive of associated edits such as NCCI;

Proven ability to manage revenue cycle and denial management activities; knowledgeable of coding and electronic medical record system workflow; Knowledgeable of CMS and Joint Commission medical record documentation requirements including ICD-9/ICD-10, CPT and APC Coding guidelines; understanding of 3rd party payer requirements and federal and state guidelines and regulations pertaining to coding and billing practices

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