Responsibilities
The System Director, Revenue Integrity, is responsible for ensuring the integrity of the hospital and physician practice revenue cycle, assuring documentation reflecting registration, clinical service delivery, charging, coding, billing and remittance are accurate, complete, comprehensive and in compliance with regulatory and payor requirements.
Key Accountabilities:
- Directs ongoing programs for education of physicians and ancillary staff regarding documentation and regulatory compliance. Monitors CMS regulatory environment and integrates these requirements into facility/practice processes.
- Provides support to Patient Financial Services to ensure accurate billing and payment compliance. Assists in compliance issues and reviews billing edit issues including APC grouper edits, Emdeon and LMRP reviews. Serves as a member of the Billing and Documentation Committee for both the hospital and physicians to ensure compliance.
- Provides support and education to Norton Healthcare coders to improve accurate coding for appropriate reimbursement. This will include Hospital, Physician Services and Norton Cancer Institute. Plans the coding audits to assess compliance with applicable coding guidelines.
- Monitors the CDM to ensure proper charge capture and reimbursement. Interacts with various clinical and support departments and systems influencing charge propriety. Maintains mechanisms to ensure accurate charge capture.
- Performs financial analysis of revenue and reimbursement performance. Functions as an integral link between clinical and financial departments. Provides support to evaluate future service line development regarding reimbursement potential.
Qualifications
Required:
- Five years management in a healthcare setting
- Bachelor Degree
Desired:
- One year working with Epic
- Master Degree
- Certified Coding Specialist OR Certified Professional Coder
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