The Director provides management oversight of all charge capture and revenue integrity activities including, but not limited to regulatory compliance audits, charge integrity assessments, charge description master reviews, and other operations support activities. The Director also acts as a liaison between the clinical and operational leadership. This position will have a specific focus on revenue integrity teams with the goal to enhance effectiveness of patient net revenue realization and minimize revenue leakage across the system. This involves complete capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations. This position reports to the Vice President of Revenue Cycle. Education/Experience: Masteru2019s Degree in Finance, Business, Health Care Administration, Health Information, Nursing, or equivalent work experience with coding certification.Must have the ability to plan, develop, and present educational or programmatic materials in front of an audience greater than 20.Strong organizational skills to keep track of multiple priorities of highly detailed information.Strong executive presence, including communication skills that enable appreciation of othersu2019 perspectives and the ability to offer compelling insights and recommendations.Strong quantitative, analytic, and problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions.EPIC Proficiency. Resolute Hospital Billing, Charge Capture and Charge Router Handler Task Build.Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule.Seven (7) + years experience in health care management, related field or equivalent experience in revenue cycle operations. Additionally, experience in healthcare with a progressive focus on charge to payment relationship and patient account functions and understanding of health care financing and reimbursement mechanisms along with management.Demonstrated knowledge of various hospital and professional fee coding systems including ICD-10-CM/PCS, CPT and HCPCS.Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments to include DRGs, APCs, CCI, MUEs, Medical necessity.Process strong understanding regarding billing documents and data fields for the UB04 and CMS 1500.Strong business acumen.Excellent Revenue Cycle skills.Excellent decision and analytical skillsExcellent communication skills, both written and verbalEffective problem solvingAbility to lead and build teams effectively and collaborativelyKnowledge of industry and regulatory program policies, procedures, and laws.Certifications: Certification in at least one of the following: CPC, CCS, CCS-P, COC or Certification in Auditing and/or Healthcare Compliance. Must obtain within six (6) months of hire if not certified at time of hire. Work Schedule: DaysFTE: 1.0Location: Hoover - Kankakee, IL Responsibilities:Serves as a liaison between the clinical and operational leadership.Leads, manages and improves processes, policies and procedures, and technologies.Works collaboratively with numerous other system leaders in developing and implementing systems and processes to support quality patient care.Assist as a team member in the development, implementation and maintenance of internal controls and policies to maintain sound billing practices.Establish best practice protocols and highest quality outcomes.Utilizes knowledge of federal and state regulations to ensure compliance.Provides leadership, feedback, coaching, counseling, guidance and direction on management of Revenue Integrity Operations (account and claim edit management), missing charges, charge trigger methodology, CDM, fee schedules and charge capture.Executes payer contracts to include determining payment variances with effective resolutions.Communicates performance opportunities/issues to inform management and staff at all levels; motivates and incentivizes; instills accountability; monitors productivity and quality of work; and provides technical training and leadership development courses pertinent to service line.Investigates and advises on matters relating to technical or professional billing, coding, or regulatory requirements in turn for documentation, charge capture or coding activities.Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Registers, fraud alerts, OIG advisory opinions and other relevant publications.Leads and conducts focused charge capture and coding audits on varies topic and compliance aspects.Develop, assesses, and adapts clear and effective revenue cycle and billing policies and procedures, training, communications an awareness material from a compliance prospective.
To apply please email your resume to [ Email removed ] - URL blocked - click to apply Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals® by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicagou2019s southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedication is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
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