Community Care Cooperative (C3) · 1 week ago
Director, Revenue Integrity
Boston, MA
Full-time
Hybrid
Lead/Staff, Director/Executive
$121K/yr - $148K/yr
5+ years expCommunity Care Cooperative (C3) is a non-profit, Accountable Care Organization focused on improving health and wellness. The Revenue Integrity Director will lead efforts to optimize revenue cycle processes, maintain coding accuracy, and ensure compliance with payer and regulatory requirements.
Health CareHospitalNon ProfitSocial
Responsibilities
Lead and mentor the revenue integrity team, providing guidance and support to achieve departmental goals
Develop training programs focused on documentation standards, Epic workflows, coding accuracy, and payer compliance
Promote a culture of collaboration, accountability, innovation, and continuous improvement
Contribute to shaping the vision for C3 as the preferred resource for an affordable and efficient MSO in Billing and Credentialing
Oversee revenue integrity operations to ensure accurate charge capture, compliant coding, and billing practices
Ensure compliance with federal and state regulations, including FQHC-specific guidelines and Massachusetts healthcare requirements
Conduct audits of coding, documentation, and charge routing, implementing corrective actions to eliminate recurring issues
Regularly review payer contracts, reimbursement policies, and updates to billing codes (e.g., CPT, ICD-10, HCPCS)
Collaborate with clinical and operational teams to ensure services are accurately documented and coded
Monitor charge capture processes to identify and resolve discrepancies
Works and monitors assigned charge capture WQs to resolve discrepancies and facilitate timely claims submission
Identify new revenue opportunities based on updated regulations, understanding of services provided, and documentation/chart review to support additional revenue capture
Implement quality assurance measures to enhance revenue integrity
Ensure proper coding practices across all departments, including training and support for coding staff
Conduct regular audits of coding and documentation to identify and address errors
Maintain expertise in coding standards and provide guidance on updates or changes
Serve as the primary liaison for EPIC-related revenue integrity processes, ensuring optimal system configuration and utilization
Utilize and build Epic WQs to best manage and segment the assigned work to team members to ensure productivity standards are met and all AR is managed timely
Develop and maintain reports and dashboards to track revenue integrity metrics
Prepare and present detailed analyses of revenue integrity performance, trends, and areas for improvement
Provide actionable insights to leadership on opportunities for revenue enhancement and cost containment
In conjunction with the Billing/AR Manager, monitor denial patterns and implement corrective actions to minimize recurring issues
Work closely with billing, compliance, clinical, and finance teams to align processes and optimize revenue cycle performance
Represent Revenue Integrity in audits, leadership meetings, Community Connect expansions, and system-wide initiatives
Other duties as assigned
Qualification
Required
Epic expertise in Resolute PB, Charge Router, Claims & Remittance, work queue design, data extracts, and testing leadership
Strong knowledge of Massachusetts healthcare billing regulations and payer requirements
Demonstrated leadership and ability to guide complex system builds, optimizations, and Community Connect implementations
Strong leadership, excellent communication skills across stakeholders, attention to detail, and problem-solving skills
Results driven and outcome focused
Ability to manage multiple projects simultaneously in a fast-paced, evolving environment
High attention to detail and a strong commitment to quality assurance and customer service
Must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively in the context of a rapidly changing organization
Experience with quality improvement/change management and project management
Proficiency in Microsoft Office Suite
Must have a strong commitment to quality assurance and exceptional customer service
A strong commitment to the organization's mission
A minimum of 5-7 years of experience in healthcare billing, with at least 2-3 years in a managerial role
Preferred
Certification in medical billing or coding (e.g., CRCR, CPC, CPB) is a plus
Multiple Epic revenue cycle certifications (Charge Router, PB/Resolute, or related Epic modules)
Familiarity with the MassHealth ACO program
Experience working in Federally Qualified Health Centers (FQHC)
Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Bachelor's degree in healthcare administration, business, finance, or a related field preferred
Company
Community Care Cooperative (C3)
Community Care Cooperative (C3) exists to deliver great health care to all by offering a series of health plans uniquely tailored to meet each individual’s medical needs, no matter what road they are on in their healthcare journey.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Jenny Carney
Chief Operating Officer
Recent News
2023-12-05
Company data provided by crunchbase