Region Director Revenue Cycle Revenue Integrity-Central

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Responsible but not limited to all revenue integrity related activities such as report preparation, department audits, reconciliation procedures, QA monitoring, revenue-based statistics, CDM (Charge Description Master) maintenance, training clinical staff on charge-capture processes and subsequent charge review post procedure. Has oversight of Revenue Integrity department operations for the assigned region(s).

The role oversees all market revenue integrity (RI) initiatives which include monitoring and approving all changes made to the hospital's charge description master (CDM) and fee schedules, and developing CDM strategies that will optimize revenue generation while ensuring compliance with Federal, State and payer regulations and guidelines. Responsible for managing value capture programs and tasked with root cause analysis and will coordinate with various departments to achieve solutions to revenue capture opportunities. Fosters partnering relationships with the Revenue Cycle team, System Office, Patient Financial Services, Compliance, Health Information Management department and educates hospital departments with respect to the use and maintenance of the (CDM).

This position directs all revenue integrity functions at the region level and is charged with implementing region and system level initiatives while being a Subject Matter Expert for their region. Works closely with Market CFO and is a standing member of the Market Operating Steering Committee (MOSC) for revenue cycle. Incumbent maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting CommonSpirit Health's revenue capture and integrity through evaluating the accuracy of charge capture functions, and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of Charge Capture workflow improvements.

The Region Director of Revenue Integrity will:

• Support facilitates annual CDM pricing review in alignment with Finance and Reimbursement policies and guidelines and serves as a point of contact for strategic pricing vendors.
• Maintains knowledge of and adherence to code of conduct standards, confidentiality agreements, and the organization-wide mission statement
• Review and analysis of all CDM/RI operations and financial reports
• Ensure best practice operations and process flows are being adhered to and recommend changes as necessary
• Alert System Director to any issues or potential issues as it pertains to performance from any vendor support currently being utilized
• Support the charge capture process to promote its accuracy and integrity across selected departments of the organization
• Manage Revenue Integrity staff to ensure KPIs are met

Special Knowledge, Skills, Abilities

• Ability to establish personal and professional credibility with Revenue Cycle partners and Revenue Integrity Leadership, and CommonSpirit Market Leaders, working collaboratively to maintain a cohesive environment
• Demonstrates subject matter expertise and leadership in CDM and Charge Capture to other business partner relationships – clinical, compliance, quality, finance, and information technology
• Thorough knowledge of the CDM and Charge Capture across the organization with the confidence to challenge the status quo to improve organizational effectiveness
• Ability to identify issues prior to becoming a problem and work with System Director and as needed, Market executives to implement and execute an action plan for quick resolution
• Exceptional interpersonal, communication, and presentation skills, and the ability to clearly articulate goals and expectations to Executive Leadership both within System and Markets, across the organization
• The ability to manage time and expectations and maintain flexibility in a dynamic work environment.
• The ability to prioritize and effectively respond to issues as they arise
• Advanced communication skills
• Subject matter expert in the CDM and Charge Capture
• Strong knowledge in HIM processes and best practices
• Deep familiarity with mid-revenue cycle policies and procedures
• Familiarity with management reporting, metrics, and goal setting
• Program Management

Experience: 

Ten (10) years’ experience in Healthcare related revenue cycle functions, including coding and billing guidelines

Education: 

Healthcare administration, finance, business administration or related field.

Special Skills: 

Epic experience

Licensure: 

Professional Certification or Credential from a National Organization (i.e. AHIMA, AAPC, HFMA or NAHRI)