Program Integrity Director Jobs in Hallowell, ME

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

Job Summary:

The Manager Revenue Integrity is responsible for operational leadership of the Revenue Integrity department. This position contributes to the financial strength, compliance and overall performance of Revenue Cycle operations by providing leadership for all Revenue Integrity functions, including hospital and physician (provider) services. The Manager also provides assistance to the Sr. Director Revenue Integrity. The Manager Revenue Integrity serves in a key role to monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of Revenue Integrity processes (such as charge master maintenance, charge compliance and accuracy, payment variance analytics and prevention and overall quality and accuracy of all data flowing through the revenue cycle). Data integrity and reporting of financial performance and impact of improvement initiatives and standard KPIs is required. The Manager will ensure the effectiveness of Revenue Integrity policy, practices and technology platforms. Net revenue/performance improvement goal setting, monitoring and achievement are required.

The position will provide leadership, coordination, and evaluation of Revenue Integrity and is specifically responsible for the following:

• Charge Master Maintenance and Accuracy
• Charge Capture Completeness, Accuracy and Reconciliation
• Payment Variance Analytics, Reporting and Prevention
• Regulatory Adherence across Revenue Cycle departments and organizationally
  • Provider Based Status and Facility Enrollment
• Assisting the Senior Director in building and maintaining Revenue Cycle reporting & analytics
  • Financial Improvement Goal Setting, Process Improvement, Tracking and Reporting
  • Data Trending
  • KPI and Operational Dashboards and Reports
  • Supporting Organizational Dashboards and Reports
• Vendor Management
• Revenue Informatics development and management
  • Systems Support
  • Quality
  • Training
  • Policies
  • Professional Development
  • Workflow Redesign and Enhancement
• Supporting Strategic Design of Revenue Cycle Operations
• Collaboration with Finance and Managed Care Contracting leaders to ensure optimal pricing methodology

It is critical that this position be highly effective in delivering the services described above and work harmoniously with leaders and staff across the organization. Effectiveness will be measured in terms of measurable results, commitment, staff engagement and customer satisfaction (at all levels).

1. Bachelor’s degree required, or five (5) years of relevant leadership experience in lieu of a Bachelor’s degree.

2. Ten (10) years of experience in Finance or Revenue Cycle.

3. Excellent communication and interpersonal skills

4. Strong analytical skills required

5. Advanced computer skills required

6. Strong knowledge of health plan requirements

Central Maine Healthcare Corporation offers competitive compensation and a reasonable compensation estimate for this role is $XX.XX to $XX.XX. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Full Time

Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf