Essential Functions - Director, Revenue Integrity

• Oversees development and implementation of pricing strategy and establishing prices for chargeable services for all Corewell Health. Coordinates annual chargemaster pricing defensibility studies to ensure rational, consistent, and transparent pricing. Coordinates external CDM-related regulatory audits to ensure that all information is available and completed on a timely basis.

• Knowledge and understanding of all charge processes within the organization; provides oversight to staff who assist other department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding. Ensures clinical department staff comply with established charge capture and charge reconciliation policies and procedures. Identifies and recommends opportunities for improved standardization and consistency of charge capture processes system wide.

• Responsible for the build, testing, implementation and maintenance of Chargemaster within the Epic Resolute Hospital Billing application and Professional Fee Schedule. Actively participates in maintaining relative value unit (RVU) assignments and RVU conversion for professional charges to track physician productivity and payment.

• Assesses revenue generating departments, particularly those that are high volume, high revenue, and/or high risk to ensure accurate charge capture and provides recommendations for revenue cycle process improvements.

• Responsible for the development of system wide CDM integration and standardization between hospitals CDM master files. Responsible for researching Medicare Federal Regulations and Local Coverage Determinations for all service lines. Drafts summaries, billing protocols, and training tools as needed.

• Keeps abreast of current regulatory information/guidelines and coaches' others to do the same; communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance. Participates in industry meetings and workgroups.

• Fosters teamwork and innovative thinking. Creates a spirit of teamwork and unity among department members that allows for sharing of ideas, debate and decision resolution. Builds an appreciation of diversity as well as cohesiveness, supportiveness, and working effectively together to enable each employee and the department to succeed.

• Maintains and directs team of Charge Integrity professionals. Oversees the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files a in various hospital, professional (fee schedule), and clinical systems, including oversight of annual CPT and quarterly HCPCS updates, compliance to state and federal billing / compliance regulations.

Qualifications - Director, Revenue Integrity

• Required Bachelor's Degree in Healthcare, Finance, Accounting or related field.

• Preferred Master's Degree.

• 10 years of relevant experience in Revenue Cycle Required.

• 5 years of relevant experience professional financial, reimbursement, or analysis experience Required.

• 1 year of relevant experience supervisory/management experience Preferred.

• CDM build/maintenance experience Preferred.

• CRT-Healthcare Financial Management Association (HFMA) Certification within 180 days hire required.

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