- Works closely with Internal Compliance to address and incorporate regulatory updates and GIA policy changes, and internal/external audit recommendations into existing process flows and policies.
- Ensures operations are efficient and in compliance with federal and state regulations and managed care contracts.
- Coordinates and/or provides education, training, and auditing functions relative to ensuring billing compliance for all payers.
- Creates bi-directional systems that effectively communicate information and data with various teams, providers, etc.
- Manage coding audit team activities and projects. Ensure audit outcomes are analyzed and education is developed based on outcomes
- Works closely with Compliance and Operations to generate consistent and up to date physician education content to help drive revenue integrity and best practice coding guidelines.
- Facilitate individual or group provider education sessions regarding coding best practices and clinical documentation integrity.
- Responsible for management of chargemaster optimization, compliance, and maintenance.
- Maintains reconciliation of all charges to expected charges (against appointment schedules and trending).
- Work closely with the Insurance Follow-up to identify payment and denial trends driven by coding policies and develop appropriate responses to such trends.
- Set and analyze Key Performance Indicator (KPI) data and coordinate revenue cycle analytics for key functions, utilizing available data; quantify expected revenue impact and other characteristics to support prioritization decisions.
- Assist in developing standardized policies, procedures, and staffing levels essential to the achievement of the key performance indicators.
- Actively participate in root cause analysis and coordinate resolution between appropriate parties, escalating when appropriate.
- Develop initiatives to increase operational rigor, adopt industry best practices, and improve standardization of work processes.
- Develop and implement organizational strategies for improving company growth.
- Promote collaboration and communication between RCM employees and other GIA stakeholders (including physician office staff, finance, operations, IT) to address strategic challenges.
- Build and oversee high-performing teams (on and offshore) with an orientation toward results and aligned around GI Alliance / TGIA's mission, vision, and values.
- Ensure all team members within scope of responsibility display core competencies and meet/maintain a high level of accuracy.
- Actively listens to staff ideas and concerns, assesses others communication styles and adapts to them.
- Builds trust and partnership amongst the entire team by enhancing engagement, addressing performance results, and providing coaching and mentoring.
- Maintains privacy and confidentiality per policy and HIPAA regulations.
- Performs other related duties as required and assigned.
- Excellent communication skills, both written and verbal
- Creative, strategic, and analytical skills
- Must possess leadership and persuasive skills
- Ability to influence others in a dotted-line matrixed organizational structure
- Strong presentation skills
- Ability to gather and interpret clinical and financial data
- Ability to plan, organize, prioritize, and direct the work of others
- Proficiency in all Microsoft Office applications, particularly MS Word and MS Excel
- Ability to multi-task and prioritize in fast-paced environment
- Strong attention to detail and decision-making skills
- Self-motivated with initiative.
- Strong sense of ethics.
- Ability to work efficiently both independently and in a team-oriented environment
- Knowledge of medical terminology, CPT codes, and ICD-10 codes required.
- Maintain current knowledge and adhere to appropriate regulatory standards such as Medicare.
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Director, Revenue Integrity - Dallas, United States - GI Associates & Endoscopy Center
Description
GI Alliance is seeking an experienced Director of Revenue Cycle Integrity.Duties of this position include, but are not limited to, the following:
Position purpose
The Director of Revenue Integrity is responsible for all Mid-Revenue Cycle functions including coding, documentation, data integrity, claim edits/scrubs and oversees all claim submission.
This position identifies opportunities for improvement in claim submission and revenue generation while maintaining all policies and procedures to include regulatory changes.
It is important for this candidate to stay abreast of industry topics, upcoming changes, or high-risk areas that impact aspects of the revenue cycle, specifically in the areas of inpatient and outpatient coding, Medicare guidelines and payer contracts.
As a liaison between the clinical areas and the coding and billing departments, it will be necessary to understand different functions, participate in multiple projects and maximize efficiency between teams.
Responsibilities/Duties/Functions/Tasks:
Qualifications
Education:
Bachelor's Degree preferred.
Professional Coding Certification with American Academy of Professional Coders AAPC:
Certified Professional Coder (CPC) is required. Certified Professional Medical Auditor (CPMA) is preferred.
Experience:
Five (5) years in healthcare revenue cycle coding leadership required; professional physician billing preferred; Coding Compliance Auditing preferred.
Performance Requirements:
Equipment Operated:
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Work Environment:
Leading a remote workforce and will routinely be requested to come into the office for collaborative team meetings in person when possible.
Physical Requirements:
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Position may involve standing, sitting, bending, and reaching. May work at computer monitors for prolonged periods with danger of eye strain and muscle pain. Could cause stress if the workload is heavy. May on occasion require light lifting of no greater than 20 pounds and some offsite travel.
Some travel required, to facilitate integration of new business, as well as business development opportunities. (25% or less)
GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
Please Note:
All job offers are contingent on the successful completion of pre-employment criminal history check.
NOTE:
ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.
No phone calls or agencies, please.
EEO/AA-M/F/disabled/protected veteran
Director, Revenue Integrity professionals in Dallas
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Bhaskar Rayavaram
Sr. Technology Leader
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Sarah Pray
Client Relations