Orlando, FL

Position Summary

Orlando Health is currently seeking a Senior Director of Revenue Integrity who will be responsible for supporting the enhancement and maintenance of properly functioning revenue cycle processes at Orlando Health. In addition, this individual leads the clinical documentation review processes to achieve a high standard of clinical quality and contribute to the organization?s overall financial performance. This position also aims to maximize operational efficiency by overseeing the staff functions and promoting the integrity of the revenue charge capture system.

Responsibilities

Essential Functions

• Directs and champions multiple revenue cycle initiatives across the organization to improve processes and support optimal revenue cycle performance.
• Oversees the revenue charge capture system to promote accuracy and integrity across revenue-generating departments of the organization.
• Responsible for the organization's strategic pricing strategy.
• Consults with department leaders to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source.
• Facilitates understanding, compliance, and completeness of clinical documentation while maintaining the ability to collect, analyze, and interpret data for physician endorsement of program initiatives.
• 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.
• Educates staff regarding the appropriate application of edits related to CCI, medical necessity, etc.
• Stays apprised of ICD coding standards/updates and assists in the delivery of ICD education and training to staff as needed.
• 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.
• Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable billing guidelines.
• Ensures staff members are knowledgeable about documentation needs and coding and reimbursement issues identified through documentation reviews and aggregate data analysis.

Qualifications

Education/Training

Bachelor's degree required.

Licensure/Certification

None.

Experience

• Seven (7) years of experience in managing healthcare business functions required.
• Extensive knowledge of current healthcare trends, policies, and regulations.
• Understanding of coding classification systems, such as ICD-10-CM, ICD-9-CM, MS-DRG, APR-DRG, and HCC strongly preferred.