Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc. · 1 month ago
Director of Revenue Integrity and Coding
Woburn, MA
Full-time
Onsite
Director/Executive
$150K/yr - $179K/yr
8+ years expHarvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center is a leading physician organization focused on excellence in patient care and education. The Director of Revenue Integrity and Coding will implement the Revenue Integrity program, ensure compliance in billing and coding, and develop policies to maximize revenue opportunities.
EducationHealth CareMedicalNon Profit
Hiring Manager
Erin Wood
Responsibilities
Directs and oversees HMFP ‘s professional revenue integrity including CDM management, oversight of professional coding functions to ensure billing and regulatory compliance are met. Responsible for all compliance related matters, including remediation. Ensures charge capture revenue management opportunities and HMFP clinical service line specific reimbursement and revenue management is monitored
Champions standardization of charge capture and charge reconciliation processes
Works with HMFP clinical departments to address department processes and procedures to assure timely and accurate capture of all chargeable activities
Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms
Collaborates with clinical physician leaders and departments to review new technologies and establish related charge capture and coding protocols
Maintains oversight of charge master development, working closely with revenue generating clinical departments to ensure that coding, revenue codes, description nomenclature patient billable vs. non-billable, catalog development and updates for all CDM items are appropriate, verified through monthly feedback. Ensures annual department CPT/HCPCS coding and CDM maintenance updates coincide with the CMS annual updates to the hospital outpatient prospective payment system
Collaborates with HMFP clinical service line administrators and revenue integrity staff are performing charge reconciliation activities, following industry best practices, identifying and deploying charge capture improvement initiatives. Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, establish charge capture mechanisms, and orderly and timely recording of revenue
Monitors, proposes, and minimizes billing and coding inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials/appeals
Develops and executes charge audit approach identifying department(s) for review including chart documentation on a regular basis to verify the clinical documentation supports the charges billed, prepare a summary report of findings, and share with department leadership. Oversees CDM annual audit and charge capture and coding audits to ensure adherence to standards and enterprise-wide best practices by service line/specialty
Develops and implements corrective action plan based on audit findings and works with each of the clinical departments to meet established targets and adhere to best practices. Directs and facilitates corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. This includes evaluation and identification of root causes resulting in charge capture deficiencies or lack of revenue recognition
Monitors changes in coding regulations and communicates with clinical administrative leaders to ensure adherence to new policies
Works collaboratively with the HMFP compliance team, the HMFP clinical departments, and BIDMC to ensure. adherence to established policies, government regulations and payor requirements
Directs and support managers with functional area responsibilities. Responsible for the development of staff including the following employment actions: hiring, termination, corrective action, and performance reviews
Qualification
Required
Bachelor's degree required
Certification: Certified Professional Coder (CPC) required
8-10 years related recent work experience required
Must have working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS), coding, International Classification of Diseases (ICD-10), health care documentation, and billing requirements as well as federal and state health care regulatory requirements
Advanced skills with Microsoft Office, including Outlook, Word, Excel, PowerPoint or Access and other web-based applications. Ability to produce complex documents
Strong analytical ability. Proficient skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions
Preferred
Master's Degree, preferred
HFMA Certification, preferred
Experience with stakeholder management and cross-functional partnerships helpful
Company
Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc.
Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center (HMFP) is a leading physician organization, affiliated with Harvard Medical School (HMS), and dedicated to excellence in research, teaching, and patient care.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Alexa B. Kimball, MD, MPH
CEO and President
Meghan Agnew
Vice President and Chief Financial Officer
Recent News
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