Tahoe Forest Health System
Revenue Integrity Director
Tahoe Forest Health System, Truckee, California, United States, 96161
Overview
Bargaining Unit:
Non Represented - Director Rate of Pay:
DOE The Revenue Integrity/HIM Director is a critical leadership role responsible for optimizing the organization\'s revenue cycle through strategic oversight of claim denial prevention, appeal processes, coding accuracy, and compliance with payer requirements and audit standards. This role involves leading a team, analyzing data, implementing process improvements, and collaborating with various stakeholders to ensure efficient reimbursement for services rendered and minimize financial risk associated with denied claims and audits. Essential Duties and Responsibilities
Revenue Integrity
Denial Management & Prevention Develops and implement policies and workflows to prevent denials. Analyzes denial trends to identify root causes and implement solutions. Oversees the appeals process for denied claims. Collaborates with other departments to address denial issues. Ensures compliance with payer requirements to reduce denial rates.
Coding Accuracy & Documentation Improvement
Ensures accurate billing and coding for services. Works with coders and providers to address coding problems and ensure documentation support. Oversees documentation improvement initiatives.
Insurance Audits & Compliance
Coordinates internal and external audits. Identifies and mitigates audit risks by ensuring adherence to regulations and policies. Develops tools to support compliance. Ensues processes and data meet regulatory standards.
Charge Description Master (CDM) Management
Directs and oversees the health system\'s CDM, ensuring all chargeable activities are appropriately reflected, compliant with regulations, and updated with reimbursement changes and strategic initiatives.
Health Information Management
Health Information Management Operations
Direct and oversee coding, abstracting, transcription, document imaging, record retention, and release of information functions. Ensure efficient workflows, accuracy and timely completion of HIM processes.
Regulatory Compliance
Ensure compliance with HIPAA, CMS, ACHC Accreditation, OIG, and all applicable state and federal regulations. Maintain survey readiness and implement corrective actions as needed.
Documentation Standards
Establish, monitor, and enforce medical record documentation standards. Ensure timely completion of records in compliance with organizational and regulatory requirements.
Privacy and Security
Oversee health information privacy and security policies and procedures. Serve as a key member of the Compliance Committee regarding audits, investigations and policy updates.
Technology & Data Governance
Provide leadership for EHR optimization to improve usability, data accuracy, and clinical workflows. Partner with IT and clinical leaders to advance data governance initiatives. Ensure health information data supports quality, patient safety, and operational reporting.
Strategic Leadership
Develops and implements strategies, policies, and procedures for mid-revenue cycle operations, aligning them with TFHS overall goals.
Team Leadership and Development
Supervises, mentors, and coaches the revenue integrity and HIM team, fostering a strong team environment through training and professional development to achieve the highest level of competency. Can involve managing charge capture auditors, CDM maintenance specialists, and process improvement/training specialists.
Compliance & Risk Mitigation
Ensures compliance with applicable regulatory guidelines, established departmental policies and procedures, and quality assurance programs. Identifies, analyzes, interprets, and monitors regulatory requirements and trends that may have a financial or operational impact. Prevents and mitigates risks related to revenue delays, revenue leakage, degradation, and compliance issues.
Cross-Department Collaboration
Serves as a liaison and collaborates with various departments, such as finance, IT, coding, clinical departments, and compliance, to standardize and optimize charging workflows, business processes, billing, denial management, and collections to reduce revenue leakage.
Data Analysis & Reporting
Monitors, evaluates, and tracks key metrics and insights, reporting progress toward work plan activities and reactive tasks to senior leadership. Designs reports relevant to clinical areas and presents on the total professional revenue picture and its management.
Oversees technical billing integration and manages vendor relationships. Develops and delivers training programs for staff on coding and revenue integrity principles. Leads and coordinates ongoing charge capture improvement initiatives. Manages denials and underpayment systems, including audit/appeal workflows. Assists in developing detailed project plans for implementations. Demonstrates Health System Values in performance and behavior. Complies with Health System policies and procedures. Other duties as may be assigned. Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Supervisory Responsibilities Carries out supervisory responsibility in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, training, assigning, coaching, counseling, and disciplining employees; administering scheduling systems; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; enforcing policies and procedures. Minimum Education/Experience
Bachelor\'s Degree Health Information Management, Health Administration, or in a related area such as business or finance and 10 years + relevant experience Required Licenses/Certifications Registered Health Information Administrator (RHIA) Upon hire Either RHIA or RHIT acceptable Registered Health Information Technician (RHIT) Upon hire Either RHIA or RHIT acceptable Other Experience/Qualifications
Required: Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, MS-DRG, and APC reimbursement methodologies. Comprehensive understanding of federal and state healthcare regulations, payer requirements, and accreditation standards. Strong analytical and financial acumen with the ability to interpret and act on complex clinical and financial data. Exceptional communication and interpersonal skills with the ability to work across clinical, financial, and administrative teams. Proficiency in EHR systems (Epic preferred) and revenue cycle applications. Demonstrated leadership in change management and process improvement. Experience leading teams in a complex health system environment. Preferred: Master\'s Degree Certifications:
Certified Revenue Integrity Professional (CRIP) Certified Healthcare Revenue Integrity (CHRI) Clinical Documentation Improvement Practitioner (CDIP) Certified Coding Specialist (CCS) Certified in Healthcare Compliance (CHC) Lean Six Sigma (Green/Black Belt)
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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Bargaining Unit:
Non Represented - Director Rate of Pay:
DOE The Revenue Integrity/HIM Director is a critical leadership role responsible for optimizing the organization\'s revenue cycle through strategic oversight of claim denial prevention, appeal processes, coding accuracy, and compliance with payer requirements and audit standards. This role involves leading a team, analyzing data, implementing process improvements, and collaborating with various stakeholders to ensure efficient reimbursement for services rendered and minimize financial risk associated with denied claims and audits. Essential Duties and Responsibilities
Revenue Integrity
Denial Management & Prevention Develops and implement policies and workflows to prevent denials. Analyzes denial trends to identify root causes and implement solutions. Oversees the appeals process for denied claims. Collaborates with other departments to address denial issues. Ensures compliance with payer requirements to reduce denial rates.
Coding Accuracy & Documentation Improvement
Ensures accurate billing and coding for services. Works with coders and providers to address coding problems and ensure documentation support. Oversees documentation improvement initiatives.
Insurance Audits & Compliance
Coordinates internal and external audits. Identifies and mitigates audit risks by ensuring adherence to regulations and policies. Develops tools to support compliance. Ensues processes and data meet regulatory standards.
Charge Description Master (CDM) Management
Directs and oversees the health system\'s CDM, ensuring all chargeable activities are appropriately reflected, compliant with regulations, and updated with reimbursement changes and strategic initiatives.
Health Information Management
Health Information Management Operations
Direct and oversee coding, abstracting, transcription, document imaging, record retention, and release of information functions. Ensure efficient workflows, accuracy and timely completion of HIM processes.
Regulatory Compliance
Ensure compliance with HIPAA, CMS, ACHC Accreditation, OIG, and all applicable state and federal regulations. Maintain survey readiness and implement corrective actions as needed.
Documentation Standards
Establish, monitor, and enforce medical record documentation standards. Ensure timely completion of records in compliance with organizational and regulatory requirements.
Privacy and Security
Oversee health information privacy and security policies and procedures. Serve as a key member of the Compliance Committee regarding audits, investigations and policy updates.
Technology & Data Governance
Provide leadership for EHR optimization to improve usability, data accuracy, and clinical workflows. Partner with IT and clinical leaders to advance data governance initiatives. Ensure health information data supports quality, patient safety, and operational reporting.
Strategic Leadership
Develops and implements strategies, policies, and procedures for mid-revenue cycle operations, aligning them with TFHS overall goals.
Team Leadership and Development
Supervises, mentors, and coaches the revenue integrity and HIM team, fostering a strong team environment through training and professional development to achieve the highest level of competency. Can involve managing charge capture auditors, CDM maintenance specialists, and process improvement/training specialists.
Compliance & Risk Mitigation
Ensures compliance with applicable regulatory guidelines, established departmental policies and procedures, and quality assurance programs. Identifies, analyzes, interprets, and monitors regulatory requirements and trends that may have a financial or operational impact. Prevents and mitigates risks related to revenue delays, revenue leakage, degradation, and compliance issues.
Cross-Department Collaboration
Serves as a liaison and collaborates with various departments, such as finance, IT, coding, clinical departments, and compliance, to standardize and optimize charging workflows, business processes, billing, denial management, and collections to reduce revenue leakage.
Data Analysis & Reporting
Monitors, evaluates, and tracks key metrics and insights, reporting progress toward work plan activities and reactive tasks to senior leadership. Designs reports relevant to clinical areas and presents on the total professional revenue picture and its management.
Oversees technical billing integration and manages vendor relationships. Develops and delivers training programs for staff on coding and revenue integrity principles. Leads and coordinates ongoing charge capture improvement initiatives. Manages denials and underpayment systems, including audit/appeal workflows. Assists in developing detailed project plans for implementations. Demonstrates Health System Values in performance and behavior. Complies with Health System policies and procedures. Other duties as may be assigned. Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Supervisory Responsibilities Carries out supervisory responsibility in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, training, assigning, coaching, counseling, and disciplining employees; administering scheduling systems; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; enforcing policies and procedures. Minimum Education/Experience
Bachelor\'s Degree Health Information Management, Health Administration, or in a related area such as business or finance and 10 years + relevant experience Required Licenses/Certifications Registered Health Information Administrator (RHIA) Upon hire Either RHIA or RHIT acceptable Registered Health Information Technician (RHIT) Upon hire Either RHIA or RHIT acceptable Other Experience/Qualifications
Required: Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, MS-DRG, and APC reimbursement methodologies. Comprehensive understanding of federal and state healthcare regulations, payer requirements, and accreditation standards. Strong analytical and financial acumen with the ability to interpret and act on complex clinical and financial data. Exceptional communication and interpersonal skills with the ability to work across clinical, financial, and administrative teams. Proficiency in EHR systems (Epic preferred) and revenue cycle applications. Demonstrated leadership in change management and process improvement. Experience leading teams in a complex health system environment. Preferred: Master\'s Degree Certifications:
Certified Revenue Integrity Professional (CRIP) Certified Healthcare Revenue Integrity (CHRI) Clinical Documentation Improvement Practitioner (CDIP) Certified Coding Specialist (CCS) Certified in Healthcare Compliance (CHC) Lean Six Sigma (Green/Black Belt)
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr