Director, Transformation Services - Revenue Integrity

Job Purpose The Director, Transformation Services – Revenue Integrity will be a part of our Revenue Cycle Transformation division, which plays a pivotal role in driving the financial success of our organization and our customers. The team is responsible for leading and implementing initiatives that enhance revenue cycle performance, optimize operational efficiency, and improve financial outcomes. The position demands a strong revenue cycle background and experience leading assessments and implementation initiatives within health systems and medical groups. You will perform audits, consolidations, and standardizations of Charge Data Masters (CDM/CGT) and Revenue Integrity workflows. In addition, you will improve charge capture accuracy through workflow assessments, coordinating coding reviews, process improvements, and report generation. The Director, Transformation Services – Revenue Integrity should possess exceptional communication, critical thinking, and client relationship skills, along with a deep understanding of revenue cycle management and evolving payer requirements.

Duties and Responsibilities

• Lead and drive Revenue Integrity revenue cycle transformation initiatives to maximize efficiency and effectiveness of full end-to-end revenue cycle operations and services for clients
• Effectively manage project plans including meeting deadlines and manage on time deliverables
• Prepare comprehensive reports, presentations and documentation as required to monitor, evaluate, and communicate the effectiveness of Revenue Integrity initiatives
• Improve tracking tools and develop KPIs and metrics to identify and quantify quality and operational performance improvement opportunities
• Act as a Revenue Integrity subject matter expert addressing inquiries from clients and team members
• Collaborate with colleagues and client counterparts to understand business challenges, adapt implementation methodologies, and approaches to ensure results align with department objectives
• Monitor analytics to report progress on any detected trends in denials and procedural problems.
• Maintain a positive and professional demeanor with clients and team members
• Develop scalable transition plans to ensure improvements are sustainable
• Assist in development and improvement of revenue cycle assessment and implementation methodologies
• Evaluate current-state operations and create the blueprint for the organizational transition from the current state to the desired future state
• Establish realistic and measurable goals and priorities aligned with organizational objectives
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field preferred
• 7+ years of proven experience in healthcare operations related to revenue integrity, coding, finance, revenue cycle management, patient accounting and/or physician billing
• 7+ years of healthcare consulting experience
• Proven success leading large-scale Revenue Integrity Strategic development and implementations
• Have a full understanding of charging capture and charge reconciliation processes, including the electronic health record charge links to the CDM and charge capture processes to ensure compliance with government and third-party payer requirements
• Professional certifications such as (CPAM) or (CRCP) or demonstrated progress toward such certifications a plus
• Advanced level of Excel proficiency and experience in financial modeling and analysis
• Advanced Microsoft PowerPoint and Word skills a must; experience with SQL, SPSS, Power BI, benchmarking, MGMA survey data a plus
• Project leadership and workplan management experience for opportunity assessments within a consulting firm setting with a focus on middle revenue cycle areas (clinical documentation, revenue integrity, charging, coding)
• Possess knowledge of state and federal governmental, legal, and regulatory provisions related to middle revenue cycle operations
• Exceptional communication and interpersonal skills, with the ability to effectively interact with clients, colleagues, and stakeholders at all levels in a quickly responsive and articulate manner
• Strong analytical and problem-solving abilities, with a data-driven approach to decision-making and a focus on continuous improvement
• Ability to adapt to a fast-paced and changing environment, managing multiple priorities and deadlines effectively

Working Conditions

• Occasional travel and flexibility to work outside of normal business hours as needed.
• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Originally posted on Himalayas