Director - Revenue Cycle Integrity

Job Description

Job Description

Description : Who we are :

At STRIDE Community Health Center, we’re dedicated to more than just providing healthcare—we’re committed to making a lasting impact on the lives of our patients and the communities we serve. As one of Colorado’s largest Federally Qualified Health Centers, we offer comprehensive services—including primary care, dental, pharmacy, behavioral health, health education, and outreach—across our 13 clinics in the Denver Metro area.

With over 35 years of serving our community, our growing team is at the heart of this mission. We believe healthcare is about more than treating illness; it's about fostering wellness and addressing the unique needs of every person, ensuring that no one is left behind. If you’re passionate about making a meaningful difference, thrive in a collaborative environment, and are ready for a career that transforms lives—including your own— STRIDE is the place for you.

General Purpose :

The Director of Revenue Cycle Integrity is responsible to direct and oversee the overall policies, objectives, and initiatives of STRIDE’s revenue cycle activities and provides oversight to ensure the overall health of STRIDE’s patient and third-party receivables. Director partners with all patient care leaders to optimize the patient financial interaction along the care continuum. The desired outcome is maximizing revenue from patient services to support the overall mission of STRIDE and contribute to it being a high performing organization.

Essential Duties and Responsibilities :

• Maintains the health center's fee schedule by incorporating new charges / services, third party changes, CMS special requirement and coding updates.
• Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional billing office.
• Works collaboratively with the revenue producing department staff to ensure all charges are being captured and documented.
• Fosters partnering relationships with the Compliance Office and other third parties to ensure the accuracy of fee schedules.
• Oversee efforts to ensure timely response and compliance with regulatory agencies.
• Educates health center departments on the organization’s charging philosophy.
• Ensures timely review of regulatory literature such as Colorado Medicaid bulletins, the Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting STRIDE Community Health Center charge capture systems.
• Coordinate with other departments to ensure that the codes contained in the professional fee schedule are accurate and in compliance with regulatory and / or contractual guidelines and that claims logic is appropriate for accurate billing.
• Ensures the on-going accuracy and integrity professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments to implement necessary changes to charge documents, charge capture process, and order entry procedures.
• Identifies services that are reimbursable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes and sets rate.
• Determines charge and charge attributes for new services and products and responsible for developing and maintaining a rate setting policy.
• Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the professional fee schedule.
• Works collaboratively with the revenue producing staff to ensure all charges are being captured and documented.
• Facilitates positive communication and build strong relationships between Revenue Cycle staff and other departmental staff and payors regarding revenue cycle matters.
• Establishes revenue cycle reporting requirements to meet the needs and expectations of all organizational leadership and ensures timely reporting of revenue cycle performance through collaboration with appropriate information sources.
• Ensures that payor contract performance is monitored.
• Participate in various information technology changes which affect the revenue cycle and leads planning initiatives for revenue cycle IT related enhancements.
• Establishes performance goals and expectations relevant to the revenue cycle. Prepares annual objectives, plan of action and budgets, as appropriate. Monitors benchmark data related to revenue cycle performance.
• Plans and schedules annual audit of selected health center departments; compares medical records against claim to ensure optimum and appropriate charge capture and coding accuracy.
• Manages and monitors the performance of external vendors.
• Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
• Participates in the creation of written Revenue Cycle guidelines, policies and standard operating procedures and ensure consistent company-wide implementation, as appropriate.
• Ensures that policy development of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State and payer regulations, guidelines and requirements.
• Perform other duties as assigned.

Requirements : STRIDE Values :

Integrity : Doing the right thing even when no one is watching

Compassion : Meeting patients where they are with empathy

Accountability : Following through on our commitments.

Respect : Valuing human dignity

Excellence : Embracing a growth mindset and striving for continuous improvement.

Education and Experience :

Skills and Expertise

Required Tools of the Job

Working Environment and Physical Activities

Office environment within a clinical setting. Enters data into computer programs via computer, mouse, and keyboard. Moves about the office environment and occasionally to other locations. Moves / transports objects up to 25 lbs. occasionally. Communicate information to others. Discerns / analyzes information from others to assist in decision making

We offer a competitive salary range of $144,000 - $173,000, depending on your experience.

This range reflects STRIDE’s good faith estimate of potential compensation at the time of posting. The final salary for the selected candidate will be determined based on several factors, including experience, education, budget, internal equity, specialty, and training.

Why STRIDE?

Join us for a fulfilling career with a comprehensive full-time benefits package that promotes professional growth, well-being, and financial security, including :

STRIDE conducts background checks, including criminal history, education, license and certification.

STRIDE is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to any characteristic protected by law.

STRIDE complies with the Americans with Disabilities Act, providing reasonable accommodations as needed.

Health and Safety Commitment :

To ensure the safety of our patients, staff, and communities, all new hires at STRIDE must receive an annual flu shot or provide an exemption, as well as undergo tuberculosis screening and testing.

Application submission closing date : [Ongoing / date]

Salary : $144,000 - $173,000