Director, Revenue Integrity
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Full-time
Compensation
USD60.8 - 80.6/hour
Posted about 3 years ago
Responsibilities
Wilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry. This is a contracted interim position for an organization that was rated as one of US News Best Hospitals 2022-23.
This is a remote full-time position at Wilshire, a healthcare organization recognized for its strong work ethic and professional excellence. The role involves conducting prospective reviews of charge capture practices, coordinating improvement tools, evaluating revenue impact, and leading projects to improve revenue compliance. The position requires a bachelor's degree and five years of related work experience.
Responsibilities:
- Conducts Prospective reviews of charge capture practices in the clinical departments and reports findings
- Provides education to staff responsible for charge capture
- Coordinates charge capture improvement tools in collaboration with Revenue Cycle IT teams
- Evaluates revenue impact, monitors ongoing compliance and expected versus actual revenue changes
- Reports potential compliance issues for further analysis and follow-up to the Compliance Department
- Facilitates clinical SME use of NThrive for submitting CDM requests with a focus on regulatory coding, compliance and adherence to SHC internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity
- Leads projects to improve revenue compliance, efficiencies in the charge capture process, and CDM charge structures
- Performs basic financial analyses to report the impact of payment changes resulting from payer practices and CMS regulation changes
- Communicates findings fully with clinical departments and executive team
- Reviews EPIC WQs, conducts research needed to resolve the account issues and identifies gross and/or net revenue benefit expected from all account corrections completed
- Develops criteria for reporting revenue performance to a variety of audiences including Faculty, DFA’s, Division and Clinic Chiefs, the Director of Revenue Integrity and others as appropriate
- Responsible for presenting reports to a variety of audiences