Froedtert Health · 1 day ago

DIRECTOR OF REVENUE INTEGRITY

United States

Full-time

Remote

Director/Executive

10+ years exp

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Responsibilities

Responsible for development, implementation and maintenance of revenue integrity functions, consistent with the mission and vision of Froedtert Thedacare Health.

Responsible for the consolidated Charge Description Master (CDM) of all Froedtert Thedacare Health entities [e.g. all hospitals, surgery centers, community physicians (CP), WDL].

Serves as the revenue integrity liaison for the Revenue Cycle and revenue producing departments.

Working closely with other departments including service line and department leaders, Managed Care and Finance, responsible for strategic pricing, both gross and net, and implementing appropriate pricing policies within the health system for all services.

Team is responsible for performing reimbursement valuation analyses to assist in payer contracting, both fee for service and value-based contracts.

Provides data analytics and reporting functions to Managed Care and Revenue Cycle to maximize net reimbursement to the organization.

This includes, but is not limited to, claims denials and underpayment analysis, strategic pricing recommendations in payer contracts, and accounting for and making recommendations related to pay-for-performance and revenue at risk programs, for both commercial and government payers.

Qualification

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Revenue Cycle OperationsHealthcare Financial ManagementMSDRG Reimbursement MethodologiesCMS OPPS Reimbursement MethodologiesCDM ManagementStrategic PricingCMS APMsReimbursement MethodologiesPayer Billing RequirementsData AnalyticsClaims Denials AnalysisCollaboration Skills

Required

A minimum of ten years of hospital or professional revenue cycle operations and progressively responsible experience in healthcare financial management is required.

Bachelor's Degree in Finance or related field is required. In lieu of Bachelors Degree, relevant work experience may be considered.

Strong knowledge of MSDRG and CMS OPPS reimbursement methodologies, CDM management, and strategic pricing are required.

Must be well versed in CMS Advanced Payment Methodologies (APMs).

Possesses strong understanding of various reimbursement methodologies and payer billing requirements.

Strong qualitative, analytic, and problem solving skills to facilitate decision making related to operational improvements.

Strong organizational, communication and collaboration skills.