Director System Revenue Integrity Job Hyannis area,Massachusetts USA,Management

Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions;
ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
annually and adjust appropriately; recognize areas of excellence.

Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational
materials within all Revenue Integrity functional areas.

Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to
identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology
enablers and proactive internal audits/reviews of charging practices.

Ensure that the CDM is compliant with regulatory and payer requirements and that all services provided have an
established charging and reconciliation methodology.

Ensure Revenue Integrity employees across all functions comply with established policies, processes, and quality
assurance programs.

Identify potential process improvements in charge capture functions, and lead the design and implementation as
required.

Monitor and facilitate service level agreements (“SLAs”) between Revenue Integrity operations and other related
functions within both Revenue Cycle and Clinical operations. This includes confirmation that charge review queues/
requests are managed appropriately.

Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including
peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance).

Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance
monitoring across all revenue integrity functions.

Ensure audit of denial management processes occurs consistently and coordinate with peers across the revenue cycle
organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs.

Oversee, measure, and report ongoing financial and operational performance of Revenue Integrity, audit and appeals
outcomes and denial management across CCHC.

Support CCHC strategic initiatives that require involvement from revenue integrity functions as required.

Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and
enable proactive performance improvement steps to be taken.

Lead the establishment and implementation of Key Performance Indicators (“KPIs") for audit and appeal functions;
ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
annually and adjust appropriately; recognize areas of excellence.

Develop reporting to support the transparency of audit and appeals outcomes

Identify potential process improvements within the audit and appeals workflows and lead the design and
implementation as required.

Develop and monitor productivity metrics for all Revenue Integrity functional areas

Oversees payment variance team members and workflows

Seeks opportunities to address and remedy system and/or payer related issues causing payment variances

Develop reporting to identify and monitor root cause payment variance issues

Reports payment variances to executive leadership

Challenges current working practices; identifies process improvement opportunities and presents recommendations
and solutions to management. Engages and commits to the organization’s culture of continuous improvement by
actively participating, supporting, and promoting CCHC Pillars of Excellence.

Bachelor's degree in Business Administration, Healthcare Management or related discipline and or equivalent
experience.
Minim…