Director System Revenue Integrity

About the role

Develops and executes the strategic vision for system-wide Hospital, Professional and Ancillary Services Revenue Integrity functions within CCHC’s Revenue Cycle organization. Provides leadership and oversight of key operational and financial decisions pertaining to all underlying functions. Functional areas that report to this position include Charge Description Master (“CDM”) maintenance, charge capture and reconciliation related functions, payment variance, audit and appeals management, and denials management process audit review. Additionally, this role is responsible for defining efforts and focus areas to address denial root cause issues. Confirms that metrics are met, charge entry rates and accuracy rates are achieved to meet yearly revenue goals.

Organization: Cape Cod Healthcare, Inc. | Location: Massachusetts‑Hyannis | Department: HCI‑Rev Cycle‑Admin

Responsibilities

• Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions; ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations annually and adjust appropriately; recognize areas of excellence.
• Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational materials within all Revenue Integrity functional areas.
• Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology enablers and proactive internal audits/reviews of charging practices.
• Ensure