Director of Revenue Integrity

Santa Barbara, California
Accounting & Auditing (Business and Financial Operations Occupations)
Job Type
Working Hours
8:00 AM - 5:00 PM
US$ 100,000 - US$ 200,000 per year
Ref. Number
Nyeche, Jenny, Spherion
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Job Description

Under the general direction and guidance of the VP, Revenue Cycle, the Director of Revenue Integrity is responsible for maximization of revenue and ensures regulatory compliance surrounding revenue collection practices. Responsible for developing standards and ensuring the integrity of facility revenue charge capture. Position includes all aspects of the Charge Description Master (CDM) and is a key contributor to fee schedule formulation(s), review and maintenance to optimize revenue generation and compliance with third party payer requirements. Collaborates with all service lines across the system and serves as a technical expert on CDM and charge capture. Develops and maintains policies and procedures relative to revenue integrity. Has direct oversight over Charge Master Analyst, Charge Audit Coordinator, and the Manager of Clinical Denials and Utilization Review.

1. Ensures regulatory compliance proactively seeking out regulatory information and changes.
2. Plans, develops and operationalizes opportunities associated with charge capture and the maximization of revenue. Proactively trends revenue patterns by service line to ensure stable revenue flows. Analyzes trends to recommend changes to charge master based upon industry trends and volume trends, including shifts from inpatient to outpatient, competitive market pricing, and service line profitability reporting.
3. Provides oversight over team members responsible for working all Revenue Integrityand ensures charge review work queues are actively managed by clinical staff.
4. Maximizes reimbursement and minimizes billing rejections by collaborating with the Director of Managed Care Contracting and trending payor patters. Directly oversees the Clinical Denials team and identifies process improvement opportunities to eliminate core elements driving denials and underpayment by payors.
5. Interfaces with and provides technical expertise regarding revenue systems, Room/Bed files, and charge system maintenance for: Clinical departments, Information Technology, Administration, Patient Financial Services (PFS), Finance, Accounting, and Contracting.
6. Maintains and promulgates Policies and Procedures related to revenue integrity and charge master practices, inclusive of regulatory requirements.

Working hours: 8:00 AM - 5:00 PM

Minimum: One or more of the following: CPC, CPC-P, CPC-H, RHIT, RHIA,CCS, RN, certification in auditing and or healthcare compliance.
Preferred: Coding certification in at least one of the following: CPC, CPC-P, CPC-H or Certification in Auditing and/or Healthcare Compliance. Must obtain or be working towards certification within one year of hire.
Minimum: Seven plus years of progressive experience in revenue cycle areas. Five years of broad-based healthcare financial management. Five years of charge-master, billing and reimbursement concepts experience. Three year of outpatient coding experience. Previous healthcare financial analysis and/or cost accounting experience. Five years of previous management and supervisory experience.


7-10 years

IF you feel that you are qualified for this position, respond to this post or contact our office with your resume!

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

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