RN Director Revenue Integrity & Clinical Integration
|Job Title||Category||Location||Job Type||Posted|
|RN Director Revenue Integrity & Clinical Integration||Management/Leadership||Miramar, Florida 33025||Full-Time||05-15-2019|
Why VITAS Healthcare and What Do They Offer Me?
VITAS Healthcare is the nation’s leading provider of end of life care. We provide our employees opportunities for professional growth, advancement and competitive benefits.
The Director Revenue Integrity & Clinical Integration is responsible for developing and executing innovative strategies to optimize revenue capture and revenue integrity across the VITAS enterprise. This position is responsible for enhancing and maintaining a properly functioning revenue cycle process through a cross-department organizational structure. Efforts and resources will be focused on continuous improvement of patient intake, integrity of revenue capture, quality of coding and effectiveness of billing, collection and cash application. Scope of role also includes Charge Description Master (CDM) maintenance, unbilled and un-accrued revenue management, Key Performance Indicator (KPI) monitoring and reporting and billing system support.
- Plan and direct complex reimbursement and performance improvement initiatives with cross-functional teams, contributing critical information required for clinical service and procuring payment.
- Proactively identify opportunities for revenue cycle improvement and serves as primary liaison with operations leadership to develop and execute system-wide revenue compliance initiatives, activities and projects.
- Serves as a strategic liaison and subject matter expert for key performance improvement initiatives between business units and their customers, both internal and external.
- Develop and implement tools designed to track and quantify losses related to regulatory compliance requirements, and review and facilitate improvements to revenue-generating system logic and processes to assure charges are accurate and revenue losses are mitigated
- Direct the investigation, mitigation, and response to all non-routine governmental reimbursement audit activity.
- Support VITAS operations and revenue cycle management with current knowledge of billing and coding regulations, Medicare and other payor-specific requirements.
- Ensures system revenue integrity through monitoring and maximizing system revenue, overseeing projects related to revenue opportunities, and management of the charge master maintenance.
- Manages the team which evaluates and resolves charge, CPT, revenue code and unit discrepancies preventing third party insurance claims from clearing edits in billing system by applying CMS CCI, NCCI, MUE and other governmental billing regulations and payer guidelines to bills in advance of submission to third party payers
- Identify programs and services where revenue enhancement opportunities exist and coordinate an infrastructure to report on variances and trends.
- Develop and rollout appropriate revenue capture education in accordance with new and shifting regulatory requirements
- Participate in committees and work groups addressing revenue compliance or audit related subject matter.
- Maintain current knowledge of applicable federal and state laws and other regulations and accreditation standards
- Monitor advances in revenue compliance and audit standards and changes in regulations to ensure organizational adaptation and compliance.
- Create process and coordinates reviews of revenue assurance developing corrective action plans around identified deficiencies
- Recommend system enhancements and keep abreast of changes in coding and reimbursement requirements for governmental programs and third party payers.
- Ensures all documentation and coding practices meet CMS guidelines and compliance policies of WHA.
- Coordinates with the Compliance department on internal and external clinical chart reviews.
- Provides Revenue Integrity workshops to providers and staff.
- Development, implementation, and adherence of new policies and procedures as indicated to continually improve operational efficiencies and quality of the services provided.
- Monitor the internal/external environment and identify opportunities to fulfill the corporate strategy.
- Create a model that supports the organization's mission and values based on an internal and external needs assessment.
- Set priorities for planning activities for assigned unit.
- Participate in policy development.
- Competitive compensation
- Health, dental, vision, life and disability insurance
- Pre-tax healthcare and dependent care flexible spending accounts
- Life insurance
- 401(k) plan with numerous investment options and generous company match
- Cancer and/or critical illness benefit
- Tuition Reimbursement
- Paid Time Off
- Employee Assistance Program
- Legal Insurance
- Roadside Assistance
- Affinity Program
- Three to five years’ experience in hospice and/or home health setting.
- Clinical experience strongly preferred.
- Firm understanding of the Medicare IPPS, OPPS and ASC payment system.
- Knowledge of federal, state and accreditation standards applicable to hospice; knowledge of governmental and other regulatory standards, requirements and guidelines related to quality improvement.
- Excellent analytical skills to analyze complex problems and develop effective solutions for correction.
- Ability to design and implement effective staff education and training programs.
- Comprehensive understanding of the entity’s revenue cycle, including a thorough understanding of proprietary system and any applicable systems and tools, the entity revenue capture and processes, and billing requirements.
- Advanced leadership skills to resolve critical issues and make strategic decisions to contribute to the organizational goals and objectives
- Ability to utilize and administer the disciplinary action process through coaching and counseling to improve performance or terminate employment
- Ability to work on various assignments simultaneously
- Strong interpersonal skills within all levels of the organization
- Ability to navigate within automated systems and proficiency in Outlook, Word and Excel
- Bachelor’s degree in Nursing or Health Services related field from an accredited college or university or the international equivalent required.