What are the responsibilities and job description for the Director, Revenue Integrity - Rural Health position at USA Health?
Overview:
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.
USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.
Responsibilities:
The Rural Revenue Integrity Director position will work with our rural managed hospital partners and consult with our rural hospital Collaborative members. The RRID will oversee all activities involved in developing and implementing efficient and effective processes and internal controls at every step of the patient journey in these partner facilities. They will conduct prospective reviews of charge capture practices and report findings, provide education to relevant staff, coordinate charge capture improvement tools, evaluate revenue impact, monitor ongoing compliance and expected versus actual revenue changes. They will work with the staff of partner hospitals to ensure compliance and revenue optimization. They will maintain a focus on appropriate coding, adherence to standard guidelines for CDM maintenance, and standard naming conventions and pricing integrity. Any potential compliance issues will be sent to the Compliance Department for follow-up (do you want to specify USA Compliance Department and/or the partner hospital’s compliance dept?). RRID will provide education to the clinical staff of partner hospitals regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliant use to improve revenue. They will perform basic financial analysis to report the impact of payment changes and corrections to current practices; communicate findings fully with clinical departments and executive teams; review reports in the various EMR systems; conduct research needed to resolve account issues and identify gross compliance issues and revenue opportunities; conduct root cause analyses to correct identified charge capture issues; report the gross and net revenue differential resulting from each discovery and correction completed; develop criteria for reporting revenue performance to a variety of audiences including USA leadership, administrators, Boards and management teams or partner hospitals. These reports will display a thorough understanding of content and reasonable explanations of variations from budget. RRID must possess knowledge of management and supervision and have the ability to organize the relevant staff, including staff of other hospital entities; ability to write and speak about the analyses performed; ability to provide leadership in problem identification and issue resolution; ability to change the course of events through convincing arguments supported by data; ability to apply critical thinking skills to issues and situations; ability to mediate and solve complex work problems and issues; ability to effectively facilitate work groups to successful outcomes; interpersonal skills that allow ease of communication with clinical staff and leadership; regular and prompt attendance; ability to work schedule as defines and overtime as required; limited amount of regional travel; related duties as required.
Qualifications:
Bachelor’s degree in a related field from an accredited institution as approved and accepted by the University of South Alabama and five years of progressively responsible directly related work experience. The ability to analyze revenue data to identify trends and opportunities and present such data to a variety of audiences is required. Knowledge of coding conventions, third party payer rules and regulations, and computer systems such as Cerner Millenium and CPSI and the related interfaces is required. Any combination of education and experience that would provide the required knowledge, skills, and abilities as well as possession of any required licenses or certifications will substitute for the required education and experience.
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.
USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.
Responsibilities:
The Rural Revenue Integrity Director position will work with our rural managed hospital partners and consult with our rural hospital Collaborative members. The RRID will oversee all activities involved in developing and implementing efficient and effective processes and internal controls at every step of the patient journey in these partner facilities. They will conduct prospective reviews of charge capture practices and report findings, provide education to relevant staff, coordinate charge capture improvement tools, evaluate revenue impact, monitor ongoing compliance and expected versus actual revenue changes. They will work with the staff of partner hospitals to ensure compliance and revenue optimization. They will maintain a focus on appropriate coding, adherence to standard guidelines for CDM maintenance, and standard naming conventions and pricing integrity. Any potential compliance issues will be sent to the Compliance Department for follow-up (do you want to specify USA Compliance Department and/or the partner hospital’s compliance dept?). RRID will provide education to the clinical staff of partner hospitals regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliant use to improve revenue. They will perform basic financial analysis to report the impact of payment changes and corrections to current practices; communicate findings fully with clinical departments and executive teams; review reports in the various EMR systems; conduct research needed to resolve account issues and identify gross compliance issues and revenue opportunities; conduct root cause analyses to correct identified charge capture issues; report the gross and net revenue differential resulting from each discovery and correction completed; develop criteria for reporting revenue performance to a variety of audiences including USA leadership, administrators, Boards and management teams or partner hospitals. These reports will display a thorough understanding of content and reasonable explanations of variations from budget. RRID must possess knowledge of management and supervision and have the ability to organize the relevant staff, including staff of other hospital entities; ability to write and speak about the analyses performed; ability to provide leadership in problem identification and issue resolution; ability to change the course of events through convincing arguments supported by data; ability to apply critical thinking skills to issues and situations; ability to mediate and solve complex work problems and issues; ability to effectively facilitate work groups to successful outcomes; interpersonal skills that allow ease of communication with clinical staff and leadership; regular and prompt attendance; ability to work schedule as defines and overtime as required; limited amount of regional travel; related duties as required.
Qualifications:
Bachelor’s degree in a related field from an accredited institution as approved and accepted by the University of South Alabama and five years of progressively responsible directly related work experience. The ability to analyze revenue data to identify trends and opportunities and present such data to a variety of audiences is required. Knowledge of coding conventions, third party payer rules and regulations, and computer systems such as Cerner Millenium and CPSI and the related interfaces is required. Any combination of education and experience that would provide the required knowledge, skills, and abilities as well as possession of any required licenses or certifications will substitute for the required education and experience.
