Tufts Medical Center Director, Revenue Integrity in Boston, Massachusetts

Director, Revenue Integrity

Department: Revenue Integrity and Process Improvement

Schedule: Full-Time Regular

Shift: Day shift

Grade: 15

Hours: m-f 8-4

Job Details:

  • Bachelor's degree is required

  • 5+ years of experience is required

  • GENERAL SUMMARY:

Reporting directly to the Vice President of Revenue Cycle, the Revenue Integrity Director is responsible for overseeing the revenue integrity activities for Tufts Medical Center, the Physician Organization and Floating Hospital for Children (Tufts). This position will direct and lead activities to drive compliant net revenue capture through accurate and complete capture of charges, implementation and maintenance of the charge description master (CDM), and education of clinical operations leaders as to their roles and responsibilities for charge capture. The Director will manage the overall business planning, budgeting and evaluation of the Revenue Integrity Department's services and performance.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

Manages, coordinates, 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

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

Educates staff regarding the appropriate application of edits related to CCI, medical necessity, etc.

Maintains and enhances the CDM; 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

Collaborates in the development of programs, initiatives, and workflows to support clinical documentation guidelines

Directs the development, implementation and maintenance of revenue integrity

policies and procedures.

Develops productivity standards and performance goals, and monitors department's performance.

Provides direction regarding the department's priorities and standards.

Prepares annual departmental budget and accountable for departmental monthly expenses and budget compliance.

Maintains regular contact with staff to keep abreast of issues and to provide

feedback on overall operations and specific issues.

Assures compliance with all government regulations. Promotes compliance with established departmental policies for attendance, punctuality, procedures and safety. Complies with organizational policies and procedures.

Assumes responsibility for professional growth and development of all Revenue Integrity staff.

JOB KNOWLEDGE AND SKILLS:

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

Competency in developing efficient and effective solutions to complex business challenges

Strong leadership skills and commitment to a team approach

Ability to influence key stakeholders, including physicians, at various organizational levels

Comprehensive understanding of computer, database, and network technologies

Exceptional communication skills

Extensive experience with sophisticated and highly automated revenue cycle and proficiency with other business related software applications (e.g., MS Word, Access, Excel, Power Point and other Data Analyst tools, etc.)

Working knowledge of Cerner, Epic or SMS/Invision preferred.

EDUCATION

Bachelor's degree with 7-10 years of progressive management experience in healthcare revenue cycle environment required. Master's degree preferred.

An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements.