Director of Revenue Integrity

Company: Washington Regional
Location: Fayetteville
Posted on: February 25, 2021

Job Description:

Location: Washington Regional Medical Center - Fayetteville, AR Washington Regional Medical Center is our region's only locally governed, community-owned, not-for-profit healthcare system. Our system includes a 425-bed acute care hospital located in the heart of Fayetteville supported by our clinic system - including primary, specialty and urgent care operations - that span across Northwest Arkansas into Harrison and Eureka Springs. Being heavily supported and invested in our community makes Washington Regional a unique employer, encouraging staff to give back to the community in which we live and work --- and give back to each other. Washington Regional Mission, Vision and Values prove to be a firm foundation and inspiration from which we fulfill our purpose. Mission: Washington Regional is committed to improving the health of people in communities we serve through compassionate, high quality care, prevention and wellness education. Vision: To be the leading healthcare system in Northwest Arkansas --- the best place to receive care and the best place to give care. Values: To treat others - patients and their families, visitors, physicians, and each other - as we would want to be treated. SUMMARY The role of Director of Revenue Integrity reports to the Vice President of Revenue Cycle Services. This position is responsible for overseeing the leadership and operations of the division of Revenue Integrity, which encompasses Health Information Management, Coding, Clinical Documentation Improvement and Revenue Integrity. This position will spend 90% of the time sitting. This position with spend 10% of work time standing and/or walking short distances with occasional reaching, pulling, and/or lifting. RESPONSIBILITIES

• Promotes employee engagement to achieve a positive and productive workforce
• Ensures that the activities of the coding, charging and billing operations are conducted in a manner that is consistent with Washington Regional policy and in compliance with Federal, State, and payer regulations, guidelines, and requirements
• Plans, develops, secures approval of, implements, and adminis--ters departmental policies and procedures designed to ensure all patient records are efficiently and accurately updated, physician transcriptions are effectively processed, statisti--cal analyses and coding/abstracting are accurately completed, and that insurance/medical record legal requests for patient-related information are processed in accordance with established standards of con--fidentiality and release of information
• In consultation with Vice President of Revenue Cycle Services, develops short- and long-range goals consistent with departmental needs and Washington Regional's goals and objectives
• Develops, executes and maintains a detailed plan to improve revenue cycle performance and continually reduce days in unbilled accounts receivable, reduce denials, and improve patient and physician satisfaction
• Provide leadership, feedback, coaching, counseling, guidance and direction on management of RI Operations (account and claim edit management), missing charges, charge trigger methodology, CDM, fee schedules and charge capture
• Ability to lead and manage diverse staff in learning environment with frequent changes in departmental priorities; ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required achieving workload balance.
• Interpersonal skills necessary in order to interact effec--tively with all levels of Washington Regional personnel when gathering and exchanging medical records information and compiling new/improved medical records information, and in order to represent Washington Regional in legal proceedings
• Demonstrated ability to interpret Federal and State regulations, and accreditation standards; ability to recommend, design and implement procedures for compliance with regulations and standards; ability to negotiate with vendors, medical directors and third-party payers when appropriate, in order to facilitate compliant health record that supports patient care, research and reimbursement
• Stays current with federal, state, and commercial payer regulatory changes and updates including communicating relevant information to maintain performance and reduce the risk of audit or denials
• Demonstrated broad based knowledge of third-party payer billing requirements, medical necessity review guidelines, case mix analyses, core (quality indicators), and OIG initiatives
• Budgetary, clinical documentation and reporting expertise
• Develops, secures approval of, and administers a budget which provides for attainment of agreed-upon goals and objectives
• Supports performance improvement and Patient Safety activities
• Assures all business-related services are performed as mandated by WRMS Compliance and Code of Conduct guidelines
• Conduct regular staff meetings to communicate issues regarding the Washington Regional's mission, values, operational plans, safety, quality, and other relevant inter- and intra-depart--mental issues.
• Other duties as assigned Qualifications
  • Education: Bachelor or associate degree with a focus in Health Information Management or Healthcare Administration
  • Licensure and Certifications:. RHIT or RHIA; additional coding credentials preferred but not required, such as Certified Coding Specialist Experience:
    • 5 years of revenue cycle operational experience, required
    • Previous supervisory experience required; minimum of 3 years of experience, preferred
    • Knowledge of medical records procedures, the laws relating thereto and accreditation requirements at a level normally acquired through completion of an AHIMA (American Health Information Management Association) accredited program. In good standing, maintaining current credentials through AHIMA as an RHIA (Registered Health Information Administrator) or RHIT (Registered Health Information Technician), or Healthcare Administration degree or equivalent in related experience.
    • Current experience and familiarity with Medicare billing regulations and requirements, commercial and Medicare Advantage billing guidelines and payer reimbursement models
    • Minimum 1-year knowledge of the content, structure and maintenance of the Charge master and fee schedule
    • Knowledge of various hospital and professional fee coding systems including ICD-9/10-CM, CPT and HCPCS, required
    • Strong knowledge of quality metrics and risk adjustment factors
    • Strong quantitative, analytic, and critical thinking skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions
    • Proficient in Microsoft products and software
    • Experience with the following applications OPTUM eCAC, Centricity Business, McKesson STAR, Allscripts PM, and Greenway PM, preferred

Keywords: Washington Regional, Fayetteville , Director of Revenue Integrity, Executive , Fayetteville, North Carolina