Department: Revenue Integrity
Hours per week: 40, eligible for benefits
Shift: Monday-Friday, business hours

The Director, Revenue Integrity develops a comprehensive vision for revenue management and leads organizational strategies to achieve financial objectives.  The Director is responsible for system-level strategic planning and execution in the following areas:

• Charge Description Master (CDM) maintenance, compliance, and auditing.
• Revenue generation, reconciliation, and reporting.
• Short- and long-term strategic pricing.

This role reaches across the organization, collaborating with Managed Care, Finance, Information Technology, and clinical leadership to ensure effective, accurate, and compliant revenue generation and reimbursement.  Reporting to the Executive Director, Revenue Cycle, the Director will also support related and multidisciplinary functions and initiatives throughout Revenue Cycle and the broader organization.

Population Specific Care

• No direct patient care.

Essential Functions

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

Defines and executes strategy for CDM maintenance, compliance, and auditing.

• Directs maintenance of the hospital's charge description master (CDM) by incorporating new charges/services identified by the Revenue Integrity team, as well as the revenue generating departments, third party resources, CMS special requirements and coding updates. Oversees the monitoring and change management practices for the hospital's charge description master and professional fee schedule, ensuring consistency with third party and legislative requirements.
• Coordinates with Patient Financial Services, Health Information Management, Compliance and other coding professionals to ensure that the codes contained in the CDM and professional fee schedules are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
• Ensures timely review of regulatory literature such as Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting Children’s Hospital Colorado’s CDM and charge capture systems.
• Plans annual audit schedule for selected hospital departments; oversees charge audit functions comparing medical records to claims and ensuring optimal charge capture and compliance.
• Leads the development, implementation, and monitoring of CDM Policies and Procedures.
• Manages and monitors the performance of external vendors that provide CDM-related products and services; selects and coordinates any third-party vendor conducting annual charge master reviews or periodic updates.

Develops organizational strategy for improving revenue generation, reconciliation, and reporting

• Oversees revenue optimization function to identify reimbursable services that are not being charged; monitors charge compliance processes that ensure accurate CPT, HCPCS and revenue codes and prices.
• Educates hospital departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.
• Works collaboratively with the revenue producing department leaders, physicians, and CU Medicine to ensure all charges are being documented, captured and reconciled.
• Ensures the ongoing accuracy and integrity of the CDM and professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments and physicians to implement necessary changes to charge documents, charge capture process, and order entry procedures.
• Participates in various IT-related steering committees for information technology changes which affect the revenue cycle.  Supports design, build and implementation of revenue-generating clinical services within Epic and other IT platforms.
• Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
• Develops and produces executive-level CDM and Revenue Capture dashboard reporting, recommendations, and oversight of organization-wide CDM and Revenue Cycle strategies and process improvements.
• Leads and assists in the resolution of problems causing payer denial or failed edits as they involve the charge master and professional fee schedule, including clinical charging workflows.

Develops and executes annual and long-term strategic pricing plan

• Responsible for developing, implementing, and maintaining organizational price-setting methodology and practice.
• Directs annual internal pricing analysis, proposes annual price updates to Finance and Managed Care, and secures approval for proposed annual updates.
• Consulting with Finance, Managed Care, and senior leadership, develops and executes multi-year pricing strategy.

Supports related and multidisciplinary functions

• Participates and/or oversees joint Revenue Cycle - Managed Care working groups, with active involvement in revenue cycle and contracting strategy decisions. Ensures that payor contract performance is monitored, payment variance trends are identified, and corrective or escalation action is taken.
• Participates and/or oversees enterprise Pricing Transparency working groups and initiatives, supporting regulatory compliance, charge publication, patient estimates, and organizational communication. #LI-SE1

SCOPE AND LEVEL

Guidelines:  Guidelines are in the form of stated vision and objectives for the division.

Complexity:  Work assignment is unstructured, and leader is responsible for developing, directing, and managing outcomes and multi-year strategies in order to achieve the objectives of the operation. Duties performed include operational planning; developing standards, priorities, guidelines, processes, measurement (evaluation) systems; implementation of production and performance management standards; and allocating resources. Work is strategic and operational in nature.

Decision Making:  Employee is responsible for managing multiple functions that requires developing and implementing strategies, business plans, and policies; determining required resources; defining and evaluating performance standards; and resolving complex business problems.

Communications:  Communication at this level is internally and externally focused. Involves establishing and maintaining effective, collaborative working relationships with team members, peers, and executives. Provides information and negotiates solutions to functional issues that have major consequences or long-term significance.

Supervision Received:  Under executive direction, the employee is delegated personal responsibilities and authorities over a division (or functional area within). Executives may review work for soundness of judgment and conclusion.

• Education:  Bachelor’s degree in health care administration, business/management, finance, nursing, or a directly related field is required.
• Experience:  Minimum of five (5) years of experience directing and managing the business operations of one or more functions in a complex health care environment plus three (3) years of leadership experience. 
• Equivalency:  Minimum of eleven (11) years of experience directing and managing the business operations of one or more functions in a complex health care environment, including supervisory/leadership experience.

Ability to Perform Essential Functions of the Job

• Audio-Visual: Color Discrimination: Fair
• Audio-Visual: Depth Perception: Fair
• Audio-Visual: Far Vision: Good
• Audio-Visual: Hearing: Good
• Audio-Visual: Near Vision: Good
• Use of Hands/Feet: Both Hands - Precise Motor Function (Or Fine Manipulation)
• Weight Lifted/Force Exerted: Up to 50 pounds: Up to 1/3 of time

Work Environment

• Mental and Emotional Requirements: Independent discretion/decision making.
• Mental and Emotional Requirements: Makes decisions under pressure.
• Mental and Emotional Requirements: Manages stress appropriately.
• Mental and Emotional Requirements: Works with others effectively.
• Mental Stress: multi-tasking, meeting deadlines, prioritizing.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.  Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

Salary Information

Benefits Information

As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, 403b employer match (retirement savings), and a robust wellness program.