Senior Director, Revenue Integrity

Summary

• Position Summary
  
  • The Sr. Director of Revenue Integrity is a strategic leader responsible for driving the integrity and optimization of revenue cycle processes across MaineHealth. Reporting directly to our VP of Revenue Cycle Paul L Chausse, Jr., this role will lead the integration and standardization of both professional (PB) and hospital-based (HB) revenue integrity functions, ensuring a unified approach that maximizes revenue and ensures compliance with all regulatory requirements.
  • Leadership & Strategy: Develop and execute a comprehensive strategy for revenue integrity that aligns with MaineHealth's financial goals. This includes setting the direction for standardization and process improvements across the enterprise, and leading the integration of PB and HB functions into a single, cohesive team that operates with standardized processes and a shared mission.
  • Cross-Functional Collaboration: 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.
  • Standardization & Process Improvement: Develop and implement standardized processes across MaineHealth to optimize charge capture, ensuring consistent and accurate revenue generation.
  • Risk Management & Regulatory Compliance: Ensure rigorous compliance with all regulatory requirements, overseeing internal and external audits, including RAC, MIC, and third-party payer audits. Develop strategies to mitigate risks and address potential revenue leakage. Ensure comprehensive documentation of all chargemaster changes and adherence with governmental billing regulations.
  • Audit & Reconciliation: Oversee routine audits to identify and prevent revenue leakage, ensuring charges are accurately captured and reconciled.
  • Change Management & Technology Integration: 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.
  • Team Development & Mentorship: Lead and mentor the Revenue Integrity team, fostering a culture of collaboration, excellence, and continuous improvement. Ensure the team is well-equipped with the skills and knowledge necessary to meet the evolving demands of the healthcare environment.
  • Advanced Analytics & Reporting: Utilize data-driven insights to monitor and enhance revenue performance. Lead efforts in developing and expanding reporting tools and charge reconciliation processes, ensuring timely and accurate revenue capture. Ensure MaineHealth remains agile and responsive to emerging trends, challenges, and regulatory updates.
  • Innovation & Continuous Improvement: Champion continuous improvement by identifying opportunities for process optimization and standardization. Leverage technology and best practices to drive innovative and compliant revenue integrity functions."
• Required Minimum Knowledge, Skills, and Abilities (KSAs)
  
  • Education: Bachelor's Degree required in Health Information Management (RHIA), Business Administration, Finance, Financial Management, Finance Administration, Nursing or Information System Management. Master's degree preferred.
  • License/Certification: Coding or billing certification preferred (eg, RHIA, RHIT, RN, CCA, CCS, CRCE, CHFP, etc.). If not certified at time of hire must obtain or work towards certification within one year of hire.
  • Experience: Minimum of ten (10)+ years of progressive revenue cycle experience or an RN with leadership experience.
  • Specialized Knowledge: Demonstrated knowledge of various hospital and professional fee coding systems including ICD 9/10 CM, CPT and HCPCS. Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule. Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in both the facility and physician environments. 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. Strong organizational skills to keep track of multiple priorities of highly detailed information. Ability to lead teams, mentor, and support development of resources.

Additional Information
MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org