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Introduction

We are seeking a Director of Revenue Integrity with HealthOne to promote growth and unlock possibilities. At HCA Healthcare, we are committed to the care and improvement of human life. Share your leadership skills and come make a difference with us!

Benefits

HealthOne, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

We are seeking a Director of Revenue Integrity for our team to be an innovator. HCA Healthcare partners with Harvard Pilgrim Institute and the CDC to use our data from more than 26 million patient encounters each year to impact the industry. Come build your career with us!

Job Summary and Qualifications

The Division Director of Revenue Enhancement is responsible for providing direction and oversight of concurrent denial and underpayment tracking and prevention within the Continental Division and will assist the facilities with root cause analysis, action planning and process implementation to reduce denial/underpayment volume. The director will interact with Division and facility leadership, payers, auditors, the managed care team and the SSC (shared service center) to facilitate communication and actions related to the denial management and underpayment processes and reporting.

• Reviews daily, weekly and monthly reports, identifies opportunities for improvement and implements solutions
• Responsible for the coordination of JOC’s with the Managed Care team and payers
• Maintains a current knowledge of Corporate and Division UR requirements and billing processes
• Monitor NICU process to ascertain payments are correct
• The Division Director of Revenue Enhancement identifies improvement opportunities and facilitates process standardization to promote improved outcomes, maximize resource utilization, and improve organizational efficiencies. The director is tasked to develop and implement standard charge recognition tools, charging systems attribute monitoring, and monitoring solutions for HealthOne.
• Responsible for RI Charge Capture monthly meetings; preparing presentation, providing data to the Department Directors within the Division, and developing/tracking appropriate action plans.
• The role supports corporate charging and compliance initiatives and fosters effective communications and implementation of best practices within HealthOne (and within each affected department).
• The director is responsible for the analysis of denials, implementation of successful appeal efforts, identifying preventable denial patterns, and organizes methodical and strategic process improvements with an objective to prevent/avoid subsequent denials.
• The director oversees all NCD/LCD education and trends and reports items to the facility and Division CMO to develop any necessary action plans.
• The director of RC&A works with Division PC&A as needed for the purpose of process clarification, process improvement, and conflict resolution with payer groups regarding charging practices/methodologies.
• Provides critical information to Department Directors regarding new government and non-government billing/charging compliance processes and guidelines.
• The director aligns PSG operational improvement initiatives to Division financial action plans; this includes areas related to Central Scheduling, Order Compliance, CPT Code Compliance, Authorization Requirements, and Denial Activity within PSG.
• Identifies process improvement opportunities within the Division; develops, implements, monitors and revises action plans.
• Provides regular updates to Division and Facility Senior Leadership (CFOs, CMOs, and ECOs) on revenue opportunities, projects, and improvements.
• Responsible for directing and approving Charge Description Master (CDM) requests to ensure facility-wide standardization and that initiatives are aligned (work in conjunction with SSC Leadership).
• Facilitates education and compliance issues related to appropriate charge capture and documentation standards by working closely with PAS. Oversee the research, analysis, and education of CDM changes.

• Establishes policies/procedures as they relate to Revenue Integrity and ensure compliance with CMS and other regulations. Serves as a key liaison between the PAS, HIM, the facility, CFO, and Department Leaders.

What qualifications you will need:

• Master's degree in Business, Finance, Accounting, Healthcare Administration or related field is required
• 5 years of progressively responsible management experience in a revenue cycle position in a large hospital and or healthcare organization
• Experience with automated systems, interfaces, and implementations
• Experience with extraction of large data files for data analysis and action plan development
• Strong knowledge regarding CPT and HCPCS coding and UB revenue code assignments preferred
• Strong working knowledge of both commercial and government payer programs and reimbursement methodologies preferred
• Ability to establish and maintain long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

As part of HCA Healthcare, we at HealthONE® serve the metro Denver area as the largest healthcare system, with more than 11,000 employees. Our hospitals – The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center and Spalding Rehabilitation Hospital work together to provide a higher level of care. In addition, our system includes eight hospital freestanding emergency departments and numerous ambulatory surgery centers, eight CareNow urgent care centers and occupational medicine clinics, physician practices, medical imaging centers and AirLife Denver, which provides critical care air and ground transportation serving Colorado and surrounding states.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

Join our family of over 180 hospitals and about 2,000 sites of care to drive excellence and raise the bar for our over 35 million annual patient encounters.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.