Program Integrity Director Jobs in Nevada (NOW HIRING)

Position Purpose:

The Director of Revenue Integrity will be charged with ensuring the integrity of the revenue across all entities of the health network.   This will be accomplished through review and assurance of accurate charging, strategic price setting, use of robust denial avoidance techniques, and oversight of a training team to suppport best-in-class, patient focused revenue cycle operations with a metric-driven, performance-based culture of accountability at all levels.

Nature and Scope:

The Director of Revenue Integrity will make recommendations for improvements and initiatives to support optimal revenue capture for the organization.   The director will provide coordination and subject matter expertise across their areas of responsibility and will act as a liaison between the Revenue Cycle and other departments across the organization in developing streamlined, cost-effective, patient-centric operations that support the integrity of our current and future revenue streams.  In addition, the director will have direct responsibility to plan, organize and implement process and business improvements on designated strategic initiatives.  The director will collaborate with inter-departmental teams to effect change that is cohesive and embraced by the participants for optimal outcomes. 

Additional responsibilities include:

·         Track and benchmark revenue integrity metrics for all departments while coordinating standard usage of all system reporting.

·         Ensure optimization of the Epic System.

·         Plan and implement regular reviews as directed by the Vice President of Revenue Cycle.

·         Lead and direct the Revenue Cycle training teams to support all revenue cycle training needs and system wide training as necessary.

·         Provide for effective chart audit policy with action plans and measurable outcomes.

• Ensure compliant charging through consistent review of chargemaster services and codes throughout the health network service lines.
• Manage RAC processes and workflows throughout the health network.
• Establishes denial avoidance feedback loops and improves operational processes to enhance revenue capture.
• Develops and makes recommendations in the creation of capital and operating budgets.
• Develops and strengthens relationships with medical staff and medical center entities.
• Makes recommendations to the Vice President of Revenue Cycle regarding programs, projects, or procedures that may improve efficiency, increase cash collections, reduce bad debt, motivate staff, or in general benefit the Revenue Cycle departments.
• Identifies and implements Transformational Healthcare projects to implement change rapidly and effectively.
• Ensures standard work is documented and implemented.
• Establishes effective communication with all departments impacting revenue including HIM, Information Systems departments, and revenue producing departments to ensure cohesive process among all areas impacting Revenue Cycle.
• Monitors and implements initiatives to improve patient experience and first impression scores.

This position does not provide patient care.  

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications:  Requirements - Required and/or Preferred

Education:

Must have college-level knowledge of the English language, including reading, writing and speaking English. Bachelor’s degree required. Successful experience in a similar role may be substituted for Bachelors. Masters degree in business, accounting or finance with a Healthcare concentration preferred.

Experience:

Five + years experience directly/indirectly managing a minimum of 75+ FTEs across multiple departments and knowledge with developing and managing large operating budgets.  Five years of experience using PC spreadsheet applications. 

License(s):

None

Certification(s):

HFMA certification preferred, but not required.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.