Director of Revenue Integrity

Company Overview DOCS is looking for an Accounting Manager to handle key accounting responsibilities including accounting and operational finance duties. This role will play a key role in the company's success during a period of growth and evolution. The ideal candidate will have experience in managing the financial statement close process and the desire to work closely with other company departments to improve controls and financial operations. Position Overview The Director of Revenue Integrity is responsible for overseeing and optimizing the revenue cycle operations of the organization. This role involves ensuring accurate and compliant billing, coding, and revenue capture processes to maximize revenue and mitigate risks. The Director of Revenue Integrity will lead a team, collaborate with various departments, and implement strategies to enhance revenue integrity while maintaining compliance with industry regulations and standards. The Director of Revenue Integrity will report to the Vice President of Revenue Cycle Management. Essential Job Function/Competencies Develop and implement revenue integrity strategies, policies, and procedures to ensure accurate and compliant billing and coding practices. Collaborate with coding, billing, compliance, and clinical teams to identify and address revenue cycle improvement opportunities. Monitor and analyze revenue cycle performance metrics, identify trends, and implement corrective actions to optimize revenue capture and reduce denials. Conduct regular audits of coding, billing, and documentation practices to identify potential risks and areas for improvement. Stay current with industry regulations, coding guidelines, and reimbursement methodologies to ensure compliance and revenue optimization. Serve as a subject matter expert on revenue integrity matters, providing education and training to staff and stakeholders as needed. Participate in revenue-related committees and task forces to contribute to organizational decision-making and strategy. Prepare reports and presentations for senior leadership, outlining revenue integrity performance and recommendations for improvement. Conduct monthly audit of Supervisor QA review of staff pre-billing. Evaluate, design, and determine standard operating procedures, a management control process, and the gaps or process flaws that impact RCM. Oversee the charge master and fee schedule maintenance and provide direction to assess professional charging. Oversees and managed the companies MIPS program and promotes general awareness and education on improvement initiatives. Participates in provider education initiatives based on industry changes and results on internal and external audit findings to support best practice documentation and appropriate revenue capture. Utilizes metrics and national benchmarks to drive improved performance related to all RCM functions. Informs RCM members and applicable operational leadership about significant changes and developments. 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. Works in collaboration with operations and clinics to achieve performance accountable to industry average and best-practice RCM benchmarks for optimal financial performance. Knowledge/Skills/Abilities Demonstrates understanding of business and how actions contribute to company performance. Excellent managerial and financial skills Professional verbal and written communication skills Ability to manage multiple tasks with excellent critical thinking skills while meeting company deadlines. Well organized with the ability to maintain accuracy and confidentiality. Ability to manage large teams. Maintains a high level of confidentiality and ethical behavior. Excellent leadership communication skills Skilled at garnering trust of physicians and partnering with them in education and coaching around RCM best practices. Keeps abreast of industry trends and seeks opportunities to build knowledge and expertise via certifications, seminars, and other learning opportunities. Excellent managerial and financial skills High degree of organization with strict adherence to deadlines and a sense of urgency Education + Certification Requirements Bachelor's degree in healthcare administration or business Management (master's degree preferred) Professional Coding Certification(s) (CPC, CPC-H, CCS, CCSP) required Experience Requirements Minimum 7 years RCM management experience within a physician practice, Managed Service Organization (MSO), or other medical environment Proven experience in high-level leadership roles Experience in Dermatology or physician practice environment preferred. Strong understanding of healthcare billing, coding, and reimbursement principles, as well as industry regulations

Created: 2024-11-05