Major Responsibilities:

Establishes and maintains formal processes and internal controls to ensure new charges accurately reflect the service provided and are compliant with federal and state regulation and payer contracts​  

Provides education and consultation for the systems clinical and finance team members for charge capture inquiries.​  

Monitors reports and work queues to identify patterns of charge variance to identify opportunities for improved revenue performance.  ​  

Sets direction and performance goals for Revenue Integrity team to ensure timely and accurate charge selection reflective of patient services rendered.​  

Develops and utilizes key data indicators to monitor processes in order to streamline workflow, design operations and improve quality, service and performance.  ​  

Responsible for researching and resolving regulatory and contract compliance issues with the compliance team and system leaders. Proactively reviews federal and state regulations and payer contracts/policies for necessary changes related to coding and billing practices​  

Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.​​  

Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale​  

Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.​  

Licensure, Registration, and/or Certification Required:

None Required.

Education Required:

Bachelor's Degree in health care administration, Finance, HIM, Nursing or other related field.

Experience Required:

​Typically​ requires 7 years of experience in hospital operations management: clinical, revenue cycle, payer contracting, financial.​   

Knowledge, Skills & Abilities Required:

Strong knowledge of hospital revenue cycle operations and systems and process improvement methods​.  

Demonstrated leadership skills and ability to manage multiple priorities in a dynamic work environment.​  

Strong analytical, decision-making and prioritization skills.​  

Ability to work well within a team atmosphere while recognizing and meeting the individualized needs of customers and internal partners.​  

Excellent interpersonal, negotiation, diplomatic, problem-solving skills with the ability to successfully and positively interact with individuals across all hierarchical levels within the organization, as well as outside partners (e.g., insurance/payer representatives).​  

Knowledge of hospital reimbursement, hospital managed care contracts; government payer reimbursement regulations; knowledge of CMS billing regulations and outpatient reimbursement systems.​  

Strong knowledge of Hospital coding: ICD-10, CPT, HCPCS, Revenue Codes, DRGs; experience with hospital charge description masters (CDMs).​   

Demonstrated experience using Hospital clinical systems and Microsoft applications.​  

Physical Requirements and Working Conditions:

This position requires travel, therefore, will be exposed to weather and road conditions. ​​  

Operates all equipment necessary to perform the job.​  

Exposed to a normal office environment.

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position.  Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.