Senior Director of Clinical Revenue Integrity -Mount Sinai Health System-Corporate

Senior Director of Clinical Revenue Integrity -Mount Sinai Health System-Corporate

The Senior Director of Clinical Revenue Integrity for the Mount Sinai Health System (MSHS)and the Icahn School of Medicine at Mount Sinai (ISMMS) (which includes the MSHS and the Faculty Practice Plan) is responsible for developing standards and ensuring the revenue integrity of the integrated professional and facility clinical charge capture process. This includes fee schedule formulary reviews maintenance to optimize revenue generation compliance with third party payer requirements collaboration with all service lines and development modification and maintenance of policies and procedures. The Senior Director is also responsible for developing a revenue integrity audit/capture/reconciliation process and ensuring revenue optimization for all clinical procedures. The Senior Director will report to the Vice President Revenue Analysis and Integrity of the MSHS.

This role is responsible for leading and managing complex revenue cycle projects including driving performance and providing overall direction and oversight of the functional areas withing revenue cycle. This role will develop policies procedures and workflows related to revenue cycle functions throughout the continuum of care. This role will foster and promote a culture of excellence build trust and collaborate with internal and external stakeholders.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

1. Develop and execute a comprehensive strategy for revenue integrity that aligns with MSHS financial goals. This includes setting the direction for standardization and process improvements across the organization.
2. Build and maintain strong partnerships with clinical IT finance and operational teams to optimize implement and enforce consistent charging practices. This role is pivotal in leading the integration of clinical and financial workflows ensuring alignment between service lines and revenue integrity functions to support optimal and compliant charge capture and reconciliation.
3. Develop and implement standardized processes to optimize charge capture ensuring consistent and accurate revenue generation.
4. Ensure rigorous compliance with all regulatory requirements overseeing internal and external audits including RAC and third-party payer audits. Develop strategies to mitigate risks and address potential revenue leakage.
5. Oversee routine audits to identify and prevent revenue leakage ensuring charges are accurately captured and reconciled.
6. Lead large scale initiatives focused on Epic and technology optimization and automation to streamline revenue processes. Drive the adoption of new technologies and methodologies that enhance efficiency and ensure compliance.
7. Utilize data-driven insights to monitor and enhance revenue performance. Lead developments in developing and expanding reporting tools and charge reconciliation processes ensuring timely and accurate revenue capture. Ensure MSHS remains agile and responsive to emerging trends challenges and regulatory updates.
8. Champion continuous improvement by identifying opportunities for process optimization and standardization. Leverage technology and best practices to drive innovation and compliant revenue integrity functions.
9. Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities.
10. Analyze and influence appropriate action in all areas of reimbursement by performing appropriate reviews investigating trends and patterns and providing education regarding charge capture and charge reconciliation.
11. Ensure that controls are put in place to hold providers and departments accountable for effectively managing charge capture and reconciliation processes. Assess and determine if artificial intelligence can be leveraged to automate processes and identify opportunities for charge capture.
12. Monitor regulatory environment and implement appropriate workflow and process changes to support efficient compliant and patient-friendly departmental outcomes and results.
13. Functions as a highly visible approachable and accessible leader. Acts as a catalyst to promote positive change and stimulates others to do likewise.
14. Ensure compliance with all HIPAA privacy and security standards.
15. Conform to the established policies/ procedures/ processes/ Standards of Behavior.
16. Performs other duties as required by the Vice President Revenue Integrity and Analysis.

ESSENTIAL FUNCTIONS OF POSITION:

1. Ability to perform duties and responsibilities promptly and consistently with little direct supervision in planning and organizing his/her work.
2. Ability to objectively appraise and analyze the qualifications and performance of others as well as the ability to plan and direct their activities.
3. Ability to judge the appropriate action in response to changes circumstances or problems.
4. Ability to effectively manage change and be capable of implementing new courses of action.

MINIMUM KNOWLEDGE SKILLS AND ABILITIES REQUIRED:

1. Knowledge of various hospital and professional fee coding systems
2. Knowledge of the content structure and maintenance of the CDM and fee schedules.
3. Knowledge in healthcare compliances including privacy and security regulations confidentiality laws access and release of information.
4. Possesses strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments.
5. Strong quantitative analytic and problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions.
6. Excellent interpersonal skills and experience working with senior management and other leaders along with the ability to communicate financial concepts to others without a finance background.
7. Strong leadership skills to motivate cross-departmental teams performance towards excellence using team concepts and consensus-building management styles.
8. Demonstrated ability to engage in positive powerful persuasion with individuals or groups with diverse opinions and/ or agendas leading to outcomes that meet identified goals.
9. Ability to analyze and resolve complex problems necessary to develop and administer multifaceted revenue processes regardless of whether issues originate in an area under direct or indirect control.
10. Ability to enlist cooperation and build teams committed to carrying out initiatives in environments that may be resistant to change and not under the incumbents direct authority.
11. The ability to maintain a high level of positive energy/ creativity during periods of elevated work demands.
12. Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes.
13. Ability to develop and maintain effective relationships at all levels throughout the organization.

• Bachelors degree in finance financial management finance administration nursing or information systems management; masters preferred. Coding or billing certification preferred.

Experience Requirements

• Qualified candidates will have10 years of experience in health care management related field or equivalent experience in hospital revenue cycle operations preferably in a matrixed healthcare system along with technical expertise in the following areas:
  • Significantexperiencein revenue integrity processes and practices (including CDM charge capture coding billing and denials) and compliance.
  • Strong experiencewith EPIC Systems preferably HB Resolute Hospital Billing certification or extensive hands-on experience.
  • Highly prefer a coding certification (CCS CPC COC) or advanced certification in Health Information (RHIT or RHIA)and / or a Certified Revenue Cycle Representative (HFMA) Certification in Healthcare Revenue Integrity (CHRI)
  • Management experience overseeing teams or departments involved in revenue cycle functions is needed.
  • Ability to analyze data identify discrepancies and optimize processes for revenue integrity accuracy and efficiency.
  • Experience problem-solving / navigating complex issues in billing coding and payer negotiations and process improvement.

Non-Bargaining Unit 520 - PFS Systems - MSH Mount Sinai Hospital