ECU Health · 20 hours ago
Director, Revenue Integrity
Greenville, NC
Full-time
Hybrid
Director/Executive
8+ years expECU Health is a mission-driven academic health care system serving over 1.4 million people in eastern North Carolina. The Revenue Integrity Director will lead the Revenue Integrity team, defining strategies to maximize revenue capture and ensuring effective collaboration between clinical departments and the Revenue Cycle.
Hospital & Health Care
Responsibilities
Lead the Revenue Integrity Department in an efficient and compliant manner. Oversee monitoring and improvement efforts within the functional areas of Revenue Integrity, including:
Charge Capture - Ensure appropriate audit activities take place prior to and after billing to ensure accurate and optimal revenue capture and seek to continually improve charging processes within departments
Revenue Reconciliation - Provide oversight of Revenue Reconciliation completed by operational and clinical leads across the enterprise, including the use of appropriate tools to support revenue and charging reconciliation
CDM/CGT Management - Ensure the CDM/CGT is maintained, new codes are entered timely, and any pre-bill edits are worked timely
Strategic Pricing - Provide oversight for annual price increases across the organization. Understand pricing goals and net impact of associated price increases
Contract Management - Oversee updates on performance, including risks to payor compliance with agreed-to contract terms, and current process improvement initiatives
Payment Validation - Ensure accurate reimbursement by payors through internal processes and tertiary processes
Denial Management and Avoidable Write-Off Prevention - Utilize data analytics to identify trends and work with functional areas for future prevention
Reporting and Analytics - Provide objective analysis through advanced reporting and interpretation of findings to support Revenue Integrity processes
Oversee all functions performed by the Revenue Integrity team, including analytics and reporting, communication with departments and external stakeholders, and ongoing strategy and development of the program
Work with the Revenue Integrity team to develop meaningful metrics and key performance indicators to drive strategic analysis and decision-making
Lead targeted revenue improvement opportunities and assist with analyzing the financial impact as related to professional and hospital clinical departments
Work proactively with leadership within Revenue Cycle and Finance to prioritize areas of focus and ensure appropriate ongoing performance
Assist in the development and maintenance of appropriate controls and security of processes that lead to accurate clinical, operational, and financial operations
Act as liaison between HIM/Coding and Revenue Integrity to foster collaboration and ensure coordination of efforts between the teams, as appropriate
Uphold enterprise mission, vision, values, and ethical standards and demonstrate the behavioral and service expectations as defined in our policies and procedures
Qualification
Required
Bachelor's Degree in Business Administration, Health Care Administration, Clinical Administration, Finance, or related field required
Eight years of hospital Revenue Cycle, Revenue Integrity, and/or reimbursement experience are required, including seven years management experience, with emphasis on project management
Knowledge of Revenue Cycle processes, medical billing and coding processes, detailed accounting principles, quantitative decision making, and process analysis
Strong interpersonal skills, critical thinking skills, and the ability to communicate effectively to secure clinical and non-clinical information required for technical and operational revenue updates
Ability to work independently and take initiative across multiple workstreams
Skill in time management and project management, and multi-tasking is a must for this position
Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting
Advanced level of communication, problem solving, and organizational skills to maintain a high level of production and accuracy in an extremely task driven environment
Demonstrated expertise using Excel, PowerPoint, and Word
Ability to express ideas and communicate professionally, effectively, verbally and in writing, and to train others on technical matters
Ability to manage multiple staff members while maintaining a high level of production efficiently and effectively throughout the entire team
Excellent ability to understand and interpret statistical reports and perform quantitative analysis
Advanced skills in problem solving in a variety of settings and translation of data into actionable steps
Knowledge of insurance claim processing and third-party reimbursement
Knowledge of state and federal regulations as they pertain to billing processes and procedures
Knowledge of various types of provider reimbursement methodologies including per diems, inpatient DRG/APRDRG case rates, percent of charges, and outpatient surgery case rate methodologies such as ASC and OPPS as established by CMS
Ability to willingly accept responsibility and/or delegate responsibility
Preferred
Master's Degree preferred
Benefits
Great Benefits
Company
ECU Health
We come to work every day in order to help you and the 1.4 million people like you across eastern North Carolina.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brian Floyd
President and COO
Betsey Kirisits, PHR
HR Business Partner II
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