Director, Professional Revenue Integrity; Hybrid

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency.

If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

This position is responsible for overseeing and managing all aspects of professional service charges to secure the organization’s revenue integrity. The Director, Professional Revenue Integrity is accountable for the execution of the leadership, development, vision, operational and fiscal management of the professional services revenue integrity department. Creating a culture of development, collaboration, and continuous improvement is essential in this position. This position is responsible for establishing department level productivity and quality standards.

This position plans and oversees the completion of a full range of department activities including administrative and technical aspects of professional services revenue integrity supporting the design and implementation of effective systems to ensure accurate, compliant, and timely charging. This position maintains a thorough comprehension of revenue cycle processes including Charge Capture, Charge Reconciliation, Data Analytics, Performance Optimization, Pricing, Reimbursement and Professional Billing.

Partnering with leadership in Revenue Cycle, Clinical Departments, Networking, and Finance is essential to revenue performance across the Physician Enterprise. This leader maintains current knowledge of regulatory requirements, billing guidelines, and industry standards of pricing, including market conditions, government rates, local demographics, and economics. This position typically reports to the Vice President, Physician Enterprise Revenue Cycle.

• Seeking a candidate with leadership experience in a large hospital system or provider practice is highly preferred
• Previous Epic Revenue Integrity experience highly preferred
• Must have previous Revenue Cycle leadership experience to be considered
• Proven expertise experience in the areas of: provider charge capture, fee schedule maintenance, pricing modeling, CPT code review, workflow management and process improvement

Bachelor’s degree in Healthcare Administration, Business Management, Accounting or related field preferred.

• Certified Professional Coder (CPC)
• Certified Medical Coder (CMC)
• Epic certification such as ARCR:
  Resolute Professional Billing Claims and Billing Readiness
• Project Management Professional (PMP)

• Ten (10) years of Physician/Professional Billing experience with at least five (5) years in a management level position for a large health system required.
• Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system.
• Experience in Charge Capture, Charge Reconciliation, Charge Pricing, Charge Routing, and Reimbursement.
• Comprehensive understanding of healthcare billing and coding systems (e.g., HCPCS, ICD-10).
• Proven analytical ability, organizational and critical thinking skills to systematically analyze problems based on data analytics and devise appropriate courses of action.
• Proven track record of implementing business strategies while effectively managing details of complex, multi-faceted…