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Director, Revenue Integrity

Olathe Health

This is a Full-time position in Olathe, KS posted May 3, 2021.

We are looking for dedicated and caring professionals to join our team!  Olathe Health is a non-profit health system located in the Kansas City metropolitan area that operates:
 -Olathe Medical Center, a 300-bed general acute care facility which is recognized for its wide range of specialty care, cutting-edge technology and a dedicated medical staff with an excellent reputation,
 -Miami County Medical Center, a 39-bed general acute care facility which is nationally recognized for Patient Satisfaction, and provides quality care in numerous sub-specialties, and
 -Olathe Health Physicians, which includes freestanding primary and specialty clinics that focus on quality, patient-centered care. 
We’re currently looking for a Director, Revenue Integrity to join our Revenue Cycle team.

Position Summary:
The Director of Revenue Integrity is responsible for the day to day leadership of the outcomes necessary to ensure proper healthcare reimbursement for Olathe Medical Center (“OMC”), Miami County Medical Center (“MCMC”) and Olathe Health Physicians, (“OHPI”) (these combined entities referred to as Olathe Health System, Inc. or “OHSI”). The Director of Revenue Integrity will have a specific focus on management and leadership for the Revenue Integrity team that includes Denial Management, Appeals Management, Clinical Documentation Integrity (CDI) and Charge Description Master (CDM) with the goal to enhance the effectiveness of patient net revenue realization and to minimize revenue leakage for OHSI. This involves complete capture of patient revenue in every area that generates patient charges.

The Director of Revenue Integrity, along with their team, will have an expert understanding of the charging methodologies in place at OMC, MCMC & OHPI and support the enterprise in effective revenue realization.  The position will understand and lead both inpatient and ambulatory CDI management and guide physician relationships to support timely and accurate documentation for purposes of reporting and billing. Additionally, the position will be responsible for orchestrating a clinically driven revenue cycle denial prevention model comprised of education, interdepartmental collaboration, and data trending & analysis to ensure a prevention model of denials and appeals. The position will have a firm understanding of the governmental and non-governmental payment systems. The Director of Revenue Integrity will lead and assist in the development and implementation of process enhancements for enterprise and departmental initiatives to enhance charge capture and documentation accuracy and denial prevention to support reimbursement maximization. 

The position will continually coordinate between administrative, operational, and clinical operations staff to ensure that accounts have thorough documentation, proper coding and billed charges are captured at the appropriate time in the workflow and reimbursed according payer/contracts. The position will lead denial prevention & management for OHSI inpatient and outpatient encounters and will review trends in third party payments, compare actual payments to managed care contract reimbursement and governmental payer fee schedules.  The position will work closely with clinical teams, Case Management & Utilization Review as well as Revenue Cycle teams in support of regulatory compliance and reimbursement maximization.

Position Requirements:
Education: Minimum: 4 Year / Bachelors Degree

Experience:
Minimum:  

  • RN, or 3 years Healthcare Revenue Integrity, CDI, or Coding experience 
  • Understanding of Quality Criteria
  • Leadership experience in Acute hospital setting

Preferred:  5 years CDI or coding experience

Minimum:  

  • 3 Years – Hands on experience in analysis of revenue, appeals and denial management, contract management, CDI requirements, and reimbursement.
  • 3 Years – Extensive understanding of correct coding principles of CPT/HCSPCS and modifier selection as well as CCI edits and billing guidelines.
  • 3 Years – HIM, Case Management/Utilization Review, or Quality/Compliance experience in acute care facility. 

Preferred:
More than 5 Years – Supervisor or Managing within healthcare Revenue Cycle within the field of audit, reimbursement/contract management, Denial Management, Case Management, CDI, Compliance or Revenue Integrity.  Demonstrated experience with hospital revenue integrity analysis and revenue integrity related operations which may involve one or more of the following types of expertise:  hospital charging, diagnosis coding, revenue reconciliation, documentation analysis and/or error resolution involving hospital charges in a supervisory of lead worker capacity. 

Skills: 
Preferred:

  • Verbal Communication – Strong communicator, negotiation/persuasion skills and presentation skills necessary. Ability to provide feedback and conflict resolution to all teams, including physicians
  • Analytical – Highly analytical, detailed and independent skill to support denial review, identification of missed charge opportunities, contract/payer requirements, etc.
  • Ability to Multi-task and prioritize
  • Management Experience – 5 years of leading multiple teams, multiple initiatives, and outcomes
  • Working Knowledge of:
    • payer contract reimbursement regulations for Medicare, Medicaid and Managed Care
    • billing and charge capture principals
    • be able to perform proper revenue and reimbursement capture  
    • Physician and Hospital IP/OP/ER coding 
    • CPT, HCPCS & denial codes 
    • CDI requirement 
    • IPPS and documentation impact
    • Cerner clinical and revenue cycle
  • Collaboration – Ability to collaborate effectively with departments and team members outside of leadership responsibilities to ensure optimal process efficiencies, systems, and protocols utilization, managed and reviewed. Ability to lead and manage initiatives across departments and clinicians; ability to drive change
  • Computer Systems – Cerner, Word, Excel, Power Point, Lawson, Kronos, Cerner or Epic; Analytical abilities for identification of issues/opertunities through data extraction and analysis

Licensure/Certification:
Minimum:   If an RN – Active Registered Nurse (RN) licensure in accordance with the Kansas Nurse Licensure Compact required upon hire

Preferred: 

RHIA, RHIT, CCS, CPC/COC, CPC-H, or other coding credentials strongly preferred
Certification as a Revenue Integrity Professional (CRIP). Certification preferred within 1 year of date of hire

EEO Employer M/F/Disabled/Vet

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