Director Revenue Integrity

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

• Bachelor’s Degree in Finance or related field
• Master’s Degree preferred
  
  

Experience / Qualifications

• Experience in Leading Change.
• Minimum 5 years of Revenue Cycle Management experience; preferably patient access, billing/coding, collections, claims, and integrity audit review experience.
• Advanced certifications required (e.g., CCS, CCA, RHIT, RHIA).
• Possesses CPT and ICD-10 coding experience and revenue cycle management experience.
• Knowledge of regulatory compliance, ICD-10 and CPT-4 medical record coding and UB04 billing.
• Working knowledge of a CDM.
• Understanding of payer reimbursement procedures and methodologies.
• Excellent communication skills, both written and verbal, and interpersonal skills.
• Ability to perform oral presentation with the use of PowerPoint.
• Ability to effectively present information to leadership, and/or board of trustees.
• Strong leadership skills with an ability to motivate direct reports.
• Guides team members toward desired outcomes.
• Sets high performance standards and delivers quality services.
• Ability to perform strategic planning and prioritizing work.
• Establishes and maintains long-term customer relationships, building trust and respect by consistently exceeding expectations.
• Articulates knowledge and understanding of organizational policies, procedures, and systems. Ability to create new procedures.
• Proficiency in computer system applications.
• Applies tools and processes to successfully manage to budget and ability to develop a budget.
• Assesses work activities and allocates resources appropriately.
• Ability to work independently while effectively managing different priorities and projects.
• Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.
• Ability to identify and define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.
• Ability to analyze business situations, controls and risks, and recommend practical solutions.
  
  

Position Summary

The Director of Revenue Integrity is responsible for the daily operations of Revenue Integrity including leading and planning the revenue cycle operations for all aspects hospital charge corrections. This position is responsible for establishing, designing, implementing, and enforcing charging and reconciliation policies and procedures, as well as streamlining and creating effective charging processes across multiple departments and service lines. The goal of this Department is to ensure that revenue leakage is minimized. This position is highly visible and requires a strong leader with the ability to influence, prioritize, plan, multi-task, and direct the Revenue Integrity Team Members. Responsible for coding and charging Outpatient ER visits. Applications utilized include Excel, Word, PowerPoint, STAR, CERNER Power Chart and FirstNet, 3M, HPF, Experian Revenue Products, and others.

• Oversee daily operations of Revenue Integrity.
• Leads by example and adheres to JMC mission, vision and values. Instills the same in Team Members.
• Responsible for hiring, performance evaluations and all team member human resource activities
• Develop specific objectives, budgets, and performance standards for all team members
• Maintain and promote excellent customer service relations with all key stakeholders
• Maintains knowledge of all compliance regulations, federal and third-party payers.
• Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education
• Inform staff of relevant changes and developments in payer requirements
• Develop standard work and holds all team members accountable
• Ensure quality review measurements are in place
• Identify and implement process improvement activities
• Actively seeks ways to control costs without compromising patient safety, quality of care of the services delivered.
• Responsible for working with IT on all system upgrades/testing etc.
• Effectively uses and role models current management techniques and theories, encouraging the decision-making skills of staff members and providing insight and leadership in complex situations.
• Supervises the development of service policies, procedures, and operating guidelines. Collaborates with other services within the division. Ensures that information is disseminated to staff is monitored for effectiveness and changed as needed.
• Understands and enforces all hospital and personnel policies and procedures.
• Lead and/or serve on hospital and Patient Care Services committees, teams, and work groups as required.
• Performs other duties as assigned
  
  

Leadership Competencies

Establishing Relationships

Builds effective networks, working relationships, and alliances with a broad range of stakeholders (both internal and external) in order to collaborate effectively within divisions and across boundaries. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.

Developing Talent

Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively. Guides and supports the professional development of individuals so that they can fulfill future job/role responsibilities, define career goals, and establish development plans to achieve them; gives people constructive, developmental feedback and advice. Invests time and resources into building the capabilities of team members.

Inspiring and Motivating Others

Fosters commitment and cohesiveness by motivating, guiding, and facilitating cooperation within the organization toward goal accomplishments. Can persuade others, build consensus, and ensure cooperation from others to gain genuine acceptance for ideas and accomplish “win-win” solutions. Emphasizes the importance of people’s contributions; lets staff know why their work is important and how it will benefit themselves and others; ties work activities to people’s personal career goals and life interests.

Demonstrating Emotional Intelligence

Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.

Acting with Integrity

Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.

Acting Strategically

Makes long-range plans by formulating business objectives and setting priorities which support organizational change in light of the internal and external trends. Aligns day to day activities around broader organizational goals and objectives; prioritizes resources based on the strategic objectives of the organization; recognizes and rewards staff based on how their actions support the broader needs of the organization.

Being a Champion for Change and Innovation

Challenges the status quo; Stands alone and speaks out in defense of personal principles; Encourages people to question existing methods, practices, and assumptions. Effectively balances risk and opportunities; thinks through potential positive and negative outcomes.

Supports people in their efforts to try new things. Generates novel and valuable ideas and uses these ideas to develop new or improved processes.

Navigating Organizations

Understands the capacity, ability, and potential results of internal and external stakeholders as well as politics on organizational functioning and success. Understands the value and ability of internal and external stakeholders, as well as the effect of culture and politics on organization function. Understands how work gets done in organizations; builds networks that allow them to efficiently drive projects through the organizational structure; maximizes productivity while staying within constraints of formal organizational policies and rules.

Communicating Effectively

Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Is adept at tailoring the message to fit the interests and needs of the audience. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the organization and stakeholders.

Promoting Diversity and Inclusion

Treats all people with dignity and respect by being fair and consistent. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenges bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Setting a Strategic Vision

Acts as a catalyst for organizational change by building a shared vision with others which ensures alignment of the organization’s vision, strategic plan, mission, and values; influences others to translate vision into action. Identifies and articulates the strategic goals and direction of the organization, division, or group; establishes connections between short – term and long-term objectives.

Holding Self and Others Accountable

Sets clear performance expectations and objectives for self and others; evaluates work performance and provides feedback to others; recommends proper training and coaching when appropriate; ensures recognition for positive results and takes corrective actions to resolve performance problems as appropriate.

Physical Requirements

Requires sitting for long periods of time, also stooping, bending, standing, and stretching. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push/pull up to 40lbs., carry and lift up to 20lbs.

Threshold Requirements

• These threshold requirements are required and completed yearly basis
• Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation
• TB/PPD Surveillance Program
• Maintenance of required professional licensing and/or certification(s).
  

Licensure

• None
  
  

This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associates with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position.