The Revenue and Documentation Integrity Director is responsible for overseeing the leadership and operations of the division of Revenue Integrity enterprise-wide inclusive of all platforms nationally. Scope of oversight and leadership includes Coding, Clinical Documentation Improvement, and Revenue Integrity.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
- Develops and provides full cycle educational and training programs to pertinent staff including coding staff, clinicians, billing team, and ancillary departments. Topics of training include but are not limited to coding compliance program, documentation protocol and coding accuracy.
- Monitors and oversees coding, charging and billing operations to ensure respective activities are conducted in a manner that is consistent with policy and in compliance with Federal, State, and payer regulations, guidelines, and requirements. Identifies issues that arise from not following protocol and takes action to address any concerns.
- Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to coding practices including federal and state regulations and guidelines, CMS and OIG compliance standards.
- Applies standardized scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates review results to department management, coders, Clinicians. Escalates issues impacting the operations or business to RCM leadership.
- Makes recommendations to management for corrective action. Plans, develops, secures approval of, implements, and administers departmental policies and procedures.
- Provide leadership, feedback, coaching, counseling, guidance, and direction on management of Revenue and Documentation Integrity operations.
- 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. Demonstrating a broad-based knowledge of third party payer billing requirements, medical necessity review guidelines, case mix analyses, core (quality indicators), and OIG initiatives.
- Other various duties as assigned, including cross-training in other functional areas.
- Overseas Revenue Integrity department and Clinical Documentation Educators
EDUCATION: Minimum of Bachelor’s Degree required with a focus in Health Information Management or Healthcare Administration required.
EXPERIENCE: Minimum 5 year of experience working in health care setting with current experience and familiarity with CMS billing regulations and requirements, commercial and Medicaid billing guidelines and payer reimbursement models.
LICENSURE / CERTIFICATION
- Relevant coding certification (CPC, CPMA, CPEDC, CCS, RHIA, CDIP, etc.) required
KNOWLEDGE, SKILLS AND ABILITIES
- Extensive Clinical knowledge as obtained through training in graduate medical education (MD, APRN, PA, etc.)
- Proficient working with Microsoft Office including Word, Excel, and PowerPoint
- Knowledge of medical coding and documentation education training and development preferred
- Advanced Outlook skills
- Strong analytic and problem-solving abilities
- Excellent verbal and written communication skills
- Excellent interpersonal skills with the ability to engage at all levels of the organization
- Ability to efficiently multi-task, plan and prioritize a large volume of detail-oriented work in accordance with changing deadlines, ability to communicate goals clearly and compassionately
TYPICAL WORKING CONDITIONS
- Non-patient facing
- May be either full time remote/telework or rotate working in the office and remote/telework
- If remote, this job must be U.S. based
- Indoor work; professional office environment
- Operating computer
- Reach outward
- May require sitting or standing for long periods, including stooping, bending, stretching
- Requires occasional lifting of files and boxes weighing up to 25 lbs
- Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate copier, and other office equipment
OTHER PHYSICAL REQUIREMENTS
- Sense of sound
- Sense of touch