Director of Revenue Integrity

Reporting to the CFO/CAO, the Director of Revenue Integrity will be responsible to ensure that Amoskeag Health maximizes third party reimbursements, maintains accuracy and timeliness in the credentialing of providers, manages the Amoskeag Health fee schedules and makes recommendations for updates, and ensures the accuracy of CPT and diagnosis codes established in the practice management system.

The Director of Revenue Integrity will also ensure that processes developed will be in accordance with policies and procedures established by management, the Board of Directors, generally accepted accounting principles (GAAP), regulatory agencies such as Medicaid and Medicare, Amoskeag Health’s Corporate Compliance Plan and the requirements of the various health plans and insurance companies with which Amoskeag Health is a participating provider.

RESPONSIBILITIES:

Patient Service Revenue Analytics, Process Improvement and Reimbursement
o Develop and maintain reports to highlight areas of concern within the billing processes.
o Analyze revenue activity and identify trends requiring action to mitigate revenue loss and maximize reimbursement.

Work with CFO/CAO and others as necessary to establish work plans for resolution.
o Develop process to establish and track performance benchmarks for staff in Patient Accounts, Coding, Credentialing and Patient Access areas.
o Produce timely reports and provide data analysis on insurance carriers, providers, services, collections and write-offs.
o Verify the integrity of the billing codes within the billing system, so that they match the service codes of the carriers, and propose new codes and revise charge rates as necessary.
o Coordinate completion of coding audits and follow up for corrective action.

Identify, implement, and report on the progress of work flow process improvements to avoid coding errors and ensure coding accuracy.
o Review Amoskeag Health sliding fee scale(s) no less than annually
– include recommended changes and anticipated financial impact.

Oversee the implementation of fee schedule changes and communication to Amoskeag Health’s patient community, payers, regulatory agencies and others as needed.
o Review, evaluate and coordinate contract with third party carriers to secure Amoskeag Health’s participation with various health plans, and monitor plans’ compliance with the terms and conditions.

Identify and resolve any deviations with the health plans.
o Analyze, monitor and report on quality incentive programs’ funding available and funding achieved.
o Monitor contract renewals and changes, as well as drive contract negotiations.

Corporate Compliance
o Coordinate activities to align responsible areas of oversight to comply with the Corporate Compliance program, and work with compliance team to coordinate reviews of billing audits as necessary.
o Coordinate regular department meetings, develop the agenda, take minutes and document progress toward completion of tasks.
Staff Supervision
o Responsible for supervision of the Departmental Managers and oversight, management and coordination of effective operations of the Patient Access department and Patient Accounts, as well as Coding and Credentialing staff.
Project Management, Work Flow Analysis and Design
o Assist with and facilitate projects as directed
o Research and document flow of data from patient revenue source to financial reports to ensure accuracy of financial records, recommend changes when necessary
o Develop and implement strategies that maximize revenue and improve systems related to billing, coding, cash posting, account receivable management, patient registration and customer service.
o Drive system change and continuous process improvement within billing and credentialing systems.

Other Responsibilities:
Participate in all financial audits and any regulatory audits as they pertain to 3rd party billing.

Prepare and present information as requested.

Attend and participate in Amoskeag Health meetings as directed.

If absent, responsible for reading minutes of meetings and signing documentation.

Attend mandatory safety-related and infection control in-service training as designated by Senior
Management.

Exhibit sensitivity to cultural diversity of population being served.

Other responsibilities as assigned by supervisor.
QUALIFICATIONS:

Education/Training: Bachelor’s Degree in Accounting or Finance preferred; 5 – 7 years of experience in revenue cycle required; accounting or database management preferred; proven experience in payer contract negotiations; experience working in healthcare and/or nonprofit revenue cycle.

Familiarity with Medicaid, Medicare, and Commercial insurance billing required.

A combination of experience and education will be considered.

Skills: Understanding and knowledge of computerized practice management systems, data entry, excel, word, 3rd party billing software (Centricity), accounting practices and GAAP.

In-depth knowledge and use of excel and excel pivot tables is required.

Attention to detail and accuracy is critical.