The Revenue Integrity Director position is responsible for supporting the enhancement and maintenance of managed care contracts performance, charge master integrity and the denial/appeals program. This position also aims to maximize operational efficiency by supporting staff and contributes to the organization's overall financial performance.
*Develop, coordinate, implement, and oversee the revenue integrity program *Ensure the effectiveness of the revenue integrity program, including overall consistency and integration of integrity activities throughout the organization *Support and facilitate the annual charge description master (CDM) pricing review in alignment with finance and reimbursement policies and guidelines, and serve as a point of contact for strategic pricing vendors *Establish effective payer contracting processes and ensure staff adhere to related policies and procedures that promote efficient reimbursement that aligns with contract terms *Monitor and assist staff with payer contract negotiations, such as by reviewing internal guidelines, contract projections and past performance, and organizational goals with staff or by assisting in the development of contract options with favorable terms and concise language aligned with objectives *Ensure current contract provisions are applied correctly, such as by conducting reimbursement audits and staff performance quality reviews *Analyze contract performance and trends to predict contracts that might not be renewed and anticipate the effects of those losses; use knowledge and experience to build actionable plans to either sustain payer relationship or reduce impact of lost contract on patients and the organization *Support clinical departments related to new revenue initiatives, such as being the subject matter expert in the development of new CDMs to support the new clinical service offering *Drive communication of CDM changes to impacted clinical departments *Ensure the alignment of the revenue integrity program with applicable policies and procedures and all applicable laws, standards, and regulations *Direct the revenue integrity program *Work closely with executive management to ensure that the revenue integrity program meets applicable financial, operational, and legal requirements *Provide periodic reports to executive leadership regarding the nature, progress, and status of the revenue integrity program, any corrective action being taken, and any recommended changes *Consults with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information *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 *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
Competencies and skills: Essential: * Clear Communication Skills Both Written And Verbal * Able To Keep Confidential Information Regarding Patients, Team Members * Able To Withstand Crisis Situations * Has Skills To Provides Customer Service To Patients, Team Members And Visitors * Experience With Excel, Power Point, Word, Visio, Etc.
Education: Essential: * Bachelor's Degree in related field
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.