Senior Director Revenue Integrity
The Senior Director of Revenue Integrity is responsible for overseeing the development and implementation of current and future strategies to improve revenue results by taking a global view of registration/intake, clinical and financial processes, functions and interdependencies, working closely with the Billing, Clinical and Accounting Departments. This is meant to cement the concept of everyone in the organization being part of the larger team, at the organization level. This work is carried out in support of the mission and goals of Ryan Health.
The Senior Director will be responsible for insurance eligibility processes, reporting results and analysis, internal auditing, proper coding, charge capture, insurance contract review and oversight, analytics of key performance indicators, and identification and implementation of new and enhanced revenue opportunities.
Develops strategic plans/benchmarks for revenue cycle management and ensures goals/objectives are properly defined and clearly established.
Identifies new and enhanced revenue opportunities and manages an interdisciplinary team to implement new services to support such opportunities, including provision and claiming of service(s).
Acts as liaison with all insurance plans, reviews contracts monitors individual provider and service site enrollments and patient rosters.
Ensures accurate payment of capitation and incentives, including working with QI in managing incentive opportunities.
Develops and ensures implementation of written billing policies and procedures.
Monitors effectiveness of activities, ensuring that outstanding authorizations, billings, postings, collections and accounts receivables are within established time limits.
Enhances and standardizes workflows. Develops and implements billing practices by leveraging technology to automate and standardize processes.
Conducts performance coaching and discipline management for staff.
Consolidates status reports for monitoring weekly progress of various activities within the team.
Ensures adherence to HIPAA and security regulations.
Develops department budgets and ensures that operating expenses are within budget and guidelines by providing regular analysis and forecasts.
Responsible for measuring, monitoring and meeting key performance indicators and departmental goals in accordance with established policies and procedures and industry best practices.
Regularly provides CEO and CFO, and revenue cycle staff with revenue cycle status including reports, key performance indicator metrics, and presentations
Stays abreast of Medicare/Medicaid and third-party payer billing guidelines applicable to FQHCs and communicates these changes to all interest parties.
Immediately report any problems or unusual occurrences to supervisor.
Other special projects as assigned.
Minimum Experience and Skills Required:
Ten (10) years or related work experience
Minimum of five (5) years of experience in successfully leading and managing a high-performance revenue cycle operation, meeting or exceeding industry benchmarks
Strong, in-depth knowledge of revenue cycle management principles and practices, including: Medical billing, coding, collections, managed care products, regulatory compliance, payer credentialing, and financial reporting
Solid financial management skills, including: Budgeting, forecasting, trending, benchmarking, and financial analysis of the department performance
Strong knowledge of EHR software and billing management software
Exceptional attention to detail and accuracy
Knowledge of ICD and CPT guidelines
Familiarity with MS Office (especially Excel).
Outstanding communication skills (written and oral), organizational and leadership skills.
Education, Licenses and/or Certifications Required:
Experience with eClinicalWorks
Experience in FQHC environment
Professional, courteous and respectful attitude in dealing with patients.
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patient served (if applicable).
Commits to exceeding expectations of the patient.
Works well with others.
Contributes input to improve outcomes.
Asks others for opinions and feedback; provides feedback in a tactful respectful way
Minimal Training Time:
90 days introductory period
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit, talk and hear.
The employee is occasionally required to move about the office; use hands and fingers to feel, handle, or operate office equipment.
Specific vision abilities required by this job include close vision and the ability to adjust focus.
The work is primarily in a mental health clinic and/or general primary care setting which includes the unpredictability in behaviors of individuals and acute and chronic infectious diseases which may be contagious. Adequate preparation and precaution is necessary.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This position may be required to perform other duties. If such work becomes a permanent and regular part of the job, a new description will be prepared.
Equal Opportunity Employer
Ryan Health is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
How To Apply