Director, Revenue Integrity

Status: Full-Time | Exempt
Location: Onsite
Salary: $84,094.40 – $117,998.40 annually

Provides strategic and operational leadership for Revenue Integrity across hospital and physician services. Reports to the Vice President of Revenue Cycle and is responsible for optimizing revenue cycle performance, charge capture, CDM, compliance, reimbursement, data integrity, and net revenue performance.

Partners with Revenue Cycle, Finance, Coding, Compliance, PFS, Clinical Operations, and IT to ensure the quality, timeliness, completeness, and accuracy of revenue cycle processes and data, while driving regulatory compliance and revenue optimization.

• Lead Revenue Integrity strategy and operations across hospital and physician services
• Oversee CDM/chargemaster accuracy, charge capture, charge accuracy, reconciliation, and compliance
• Monitor and reduce payment variance, denials, underpayments, and revenue leakage through analytics and prevention strategies
• Ensure the quality, timeliness, completeness, accuracy, and integrity of data flowing through the revenue cycle
• Establish, monitor, and achieve net revenue, performance improvement, and Revenue Integrity KPI goals
• Analyze revenue cycle data to identify trends, root causes, financial risks, and improvement opportunities
• Develop executive reporting on financial performance and the measurable impact of improvement initiatives
• Ensure effectiveness of Revenue Integrity policies, practices, controls, technology platforms, and workflows
• Ensure compliance with CMS, HIPAA, MaineCare, payer, and federal/state regulations
• Lead corrective action and process improvement initiatives
• Partner with clinical and operational leaders to improve documentation, coding, charging, billing, and reimbursement
• Lead, develop, and engage Revenue Integrity staff

EDUCATION, EXPERIENCE, TRAINING

Education and Experience:

• Master’s degree preferred, Bachelor’s degree required, and
• Ten (10) years of experience in Finance or Revenue Cycle with a minimum of 5 years of experience in leadership roles.

Knowledge, Skills, and Abilities:

• Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
• Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
• Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
• Working knowledge of Medical Record, Financial Services and Healthcare Application technology.
• Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
• Able to effect collaborative alliances and promote teamwork.
• Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
• Effective organizational, planning, controlling, scheduling and project management abilities.
• Effective managerial and administrative abilities as applied to the management of multiple projects.
• Effective leadership abilities.
• Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.
• Ability to positively influence change.
• Excellent communications skills, both oral and written.
• Demonstrated ability to work well with diverse people, excellent human relation skills.
• Flexible and able to react to ever changing priorities.

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

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Central Maine Healthcare Corporation offers competitive compensation and a reasonable compensation estimate for this role is $84,094.40 to $117,998.40 annually. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf