DIRECTOR REVENUE INTEGRITY - Revenue Integrity
Company: Riverside Medical Center
Posted on: June 23, 2022
We Are Hiring!At Riverside, everyday brings new and exciting
challenges. You can expect an interesting environment where you're
part of making sure our organization is running optimally and
safely, helping keep the community healthy. We provide the kind of
paid training and opportunities that long-term careers are built on
and we recognize hard workers who strive to make a difference. You
will be able to succeed in our close-knit, safety-focused culture
working together as a team. The careers we offer are meaningful
because the work we do matters. Join us!
FTE: 1.000000Shift: DaysLocation: Hoover
The Director provides management oversight of all charge capture
and revenue integrity activities including, but not limited to
regulatory compliance audits, charge integrity assessments, charge
description master reviews, and other operations support
activities. The Director also acts as a liaison between the
clinical and operational leadership. This position will have a
specific focus on revenue integrity teams with the goal to enhance
effectiveness of patient net revenue realization and minimize
revenue leakage across the system. This involves complete capture
of patient revenue in every area that generates charges, management
in relation to charging mechanisms and triggers, ensuring clean
handoffs between clinical departments, strategic pricing, denials
management, billing management and clinical operations
- M aster's Degree in Finance, Business, Health Care
Administration, Health Information, Nursing required within 3 years
of hire , or equivalent work experience with coding
- Must have the ability to plan, develop, and present educational
or programmatic materials in front of an audience greater than
- Strong organizational skills to keep track of multiple
priorities of highly detailed information.
- Strong executive presence, including communication skills that
enable appreciation of others' perspectives and the ability to
offer compelling insights and recommendations.
- Strong quantitative, analytic, and problem-solving skills to
evaluate all aspects of a problem or opportunity and draw valid
conclusions to make or facilitate appropriate and timely
- EPIC Proficiency. Resolute Hospital Billing, Charge Capture and
Charge Router Handler Task Build.
- Demonstrated knowledge of the content, structure and
maintenance of the Charge master and fee schedule.
- Seven (7) + years experience in health care management, related
field or equivalent experience in revenue cycle operations.
Additionally, experience in healthcare with a progressive focus on
charge to payment relationship and patient account functions and
understanding of health care financing and reimbursement mechanisms
along with management.
- Demonstrated knowledge of various hospital and professional fee
coding systems including ICD-10-CM/PCS, CPT and HCPCS.
- Possess strong understanding of various reimbursement
methodologies with expert knowledge of all payer billing
requirements in both the facility and physician environments to
include DRGs, APCs, CCI, MUEs, Medical necessity.
- Process strong understanding regarding billing documents and
data fields for the UB04 and CMS 1500.
- Strong business acumen .
- Excellent Revenue Cycle skills.
- Excellent decision and analytical skills
- Excellent communication skills, both written and verbal
- Effective problem solving
- Ability to lead and build teams effectively and
- Knowledge of industry and regulatory program policies,
procedures, and laws.Certifications:
- C ertification in at least one of the following: CPC, CCS,
CCS-P, COC or Certification in Auditing and/or Healthcare
- Serves as a liaison between the clinical and operational
- Leads, manages and improves processes, policies and procedures,
- Works collaboratively with numerous other system leaders in
developing and implementing systems and processes to support
quality patient care.
- Assist as a team member in the development, implementation and
maintenance of internal controls and policies to maintain sound
- Establish best practice protocols and highest quality
- Utilizes knowledge of federal and state regulations to ensure
- Provides leadership, feedback, coaching, counseling, guidance
and direction on management of Revenue Integrity Operations
(account and claim edit management), missing charges, charge
trigger methodology, CDM, fee schedules and charge capture.
- Executes payer contracts to include determining payment
variances with effective resolutions.
- Communicates performance opportunities/issues to inform
management and staff at all levels; motivates and incentivizes;
instills accountability; monitors productivity and quality of work;
and provides technical training and leadership development courses
pertinent to service line.
- Investigates and advises on matters relating to technical or
professional billing, coding, or regulatory requirements in turn
for documentation, charge capture or coding activities.
- Keeps abreast of changing industry requirements and regulations
regarding acceptable documentation and billing practices by
reviewing Federal Registers, fraud alerts, OIG advisory opinions
and other relevant publications.
- Leads and conducts focused charge capture and coding audits on
varies topic and compliance aspects.
- Develop, assesses, and adapts clear and effective revenue cycle
and billing policies and procedures, training, communications an
awareness material from a compliance prospective.
- MASTERS DEGREE
Riverside Healthcare is revolutionizing care using leading-edge
technology to diagnose and treat patients. We are ranked top in the
nation for performance in neurosurgery, orthopedics, and heart
surgery and have also been named one of the nation's 100 Top
Hospitals by Truven Health Analytics seven times. Riverside is
nationally recognized for our specialty programs in obstetrics,
trauma, oncology, rehabilitation, geriatrics, occupational health,
psychiatric services, and treatment of alcohol and chemical
dependency, as well as patient safety. We combine innovation and
convenience at state-of-the-art facilities located in communities
throughout the greater Kankakee area.Riverside Medical Center
proves that truly progressive medicine is being delivered in
Chicago's southwest suburbs and East Central Illinois. Join a team
that is not only concerned with providing the best care possible
but also with offering a work environment of advancement and
growth. Riverside is a place that embraces a culture where opinions
count and dedications is respected, where superior performance is
rewarded with competitive salaries and excellent benefits.
Chemicals: Liquid Paper
Video Display Terminals: Average
Blood and Body Fluids: Unlikely to be exposed
TB or Airborn Pathogens: The only risk is that associated with
contact with the general public.Sensory requirements (speech,
vision, smell, hearing, touch):
Speech: Needed for training/presentations, telephone communication,
Vision: Needed for computer entry, reading memos and
Smell: Needed for electrical/fire safety.
Hearing: Needed for telephone communication, meetings and listening
to employee concerns.
Touch: Needed for writing, computer entry, filing.
Average Hours per Week: 45Shift: DaysPercentage of time during the
normal workday the employee is required to:
Reach above shoulders: 2%The weight required to be lifted each
normal workday according to the continuum described below:
Up to 10 lbs: Occasionally
Up to 20 lbs: Occasionally
Up to 35 lbs: Occasionally
Up to 50 lbs: Not Required
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements.
(Example: the distance material is carried; how high material is
Boxes of printed material (handouts) carried the length of the
hospital.Maximum consecutive time (minutes) during the normal
workday for each activity:
Reach above shoulders: 1
Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: Often
Pushing & pulling Normal weight: 50 lbs. 1/month
Fine Manipulation: Calculator, keyboard, writing
instrumentsRepetitive use of foot or feet in operating machine
control: Not Required
Environmental Factors & Special Hazards
Environmental Factors (Time Spent) :
Inside hours: 8
Outside hours : 0Temperature: Normal Range
Noise levels: Average
Humidity: Normal Range
Atmosphere:Special Hazards : None
Protective Clothing Required: None
To apply please email your resume to firstname.lastname@example.org#IND123
Keywords: Riverside Medical Center, Joliet , DIRECTOR REVENUE INTEGRITY - Revenue Integrity, Executive , Kankakee, Illinois
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