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Senior Director, Revenue Integrity

Department: Revenue Integrity
Status: 
Full Time
Shift: 
First
ReqID: req43279

Orlando Health is currently seeking a Senior Director of Revenue Integrity who will be responsible for supporting the enhancement and maintenance of properly functioning revenue cycle processes at Orlando Health. In addition, this individual leads the clinical documentation review processes to achieve a high standard of clinical quality and contribute to the organization’s overall financial performance. This position also aims to maximize operational efficiency by overseeing the staff functions and promoting the integrity of the revenue charge capture system.

 

Education/Training

Bachelor’s degree required.

Licensure/Certification

None.

Experience

·         Seven (7) years of experience in managing healthcare business functions required.

·         Extensive knowledge of current healthcare trends, policies, and regulations.

·         Understanding of coding classification systems, such as ICD-10-CM, ICD-9-CM, MS-DRG, APR-DRG, and HCC strongly preferred.

Essential Technical/Motor Skills

ADA minimum for essential functions.

Essential Mental Abilities

ADA minimum for essential functions.

Essential Sensory Requirements

ADA minimum for essential functions.

Essential Physical Requirements

ADA minimum for essential functions.

Exposure to Hazards

Rarely/Never.

Essential Functions

·         Directs and champions multiple revenue cycle initiatives across the organization to improve processes and support optimal revenue cycle performance.

·         Oversees the revenue charge capture system to promote accuracy and integrity across revenue-generating departments of the organization.

·         Responsible for the organization’s strategic pricing strategy.

·         Consults with department leaders to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source.

·         Facilitates understanding, compliance, and completeness of clinical documentation while maintaining the ability to collect, analyze, and interpret data for physician endorsement of program initiatives.

·         Identifies opportunities for charge capture improvement by implementing and analyzing the results of routine and/or random audits.

·         Develops tools for the purposes of tracking and identifying potential areas of lost revenue.

·         Educates staff regarding the appropriate application of edits related to CCI, medical necessity, etc.

·         Says apprised of ICD coding standards/updates and assists in the delivery of ICD education and training to staff as needed.

·         Helps maintain and enhance the chargemaster; reviews organizational charge structures to ensure charges accurately reflect services and supplies provided and are consistent with current industry best practices.

·         Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable billing guidelines.

·         Ensures staff members are knowledgeable about documentation needs and coding and reimbursement issues identified through documentation reviews and aggregate data analysis.

Other Related Functions   

·         Competency in developing efficient and effective solutions to complex business challenges.

·         Ensures revenue and clinical quality continue to meet or surpass organization/industry standards.

·         Ensures revenue cycle functions are completed with a high degree of quality and accuracy, and all interactions with staff are handled in a positive manner.

 

 

ADDRESS: 45 W. Crystal Lake St. (Sodo) Orlando FL 32806

ABOUT ORLANDO HEALTH

Orlando Health, headquartered in Orlando, Florida, is a not-for-profit healthcare organization with $7.1 billion of assets under management that serves the southeastern United States.

Founded more than 100 years ago, the healthcare system is recognized around the world for its pediatric and adult Level One Trauma program as well as the only state-accredited Level Two Adult Trauma Center in Pinellas County. It is the home of the nation’s largest neonatal intensive care unit under one roof, the only system in the southeast to offer open fetal surgery to repair the most severe forms of spina bifida, the site of an Olympic athlete training facility and operator of one of the largest and highest performing clinically integrated networks in the region. Orlando Health is a statutory teaching system that pioneers life-changing medical research. The 3,200-bed system includes 15 wholly-owned hospitals and emergency departments; rehabilitation services, cancer and heart institutes, imaging and laboratory services, wound care centers, physician offices for adults and pediatrics, skilled nursing facilities, an in-patient behavioral health facility, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with CareSpot Urgent Care. Nearly 4,200 physicians, representing more than 80 medical specialties and subspecialties have privileges across the Orlando Health system, which employs nearly 22,000 team members. In FY20, Orlando Health served nearly 150,000 inpatients and nearly 3.1 million outpatients. During that same time period, Orlando Health provided approximately $760 million in total value to the communities it serves in the form of charity care, community benefit programs and services, community building activities and more. Additional information can be found at http://www.orlandohealth.com, or follow us on LinkedIn, Facebook, Instagram and Twitter @orlandohealth.