Senior Director of Revenue Integrity
UW Medicine's mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals.
Become part of our team and join our mission to make life healthier for everyone in our community.
The Senior Director of Revenue Integrity is a key member of the Enterprise Revenue Cycle (ERC) team. This role reports to the Assistant Vice President of Enterprise Revenue Cycle. ERC is accountable for Revenue Cycle operations and performance across the majority of UW Medicine. The UW Medicine Revenue Integrity Department develops and coordinates operations and programs that oversee a wide range of revenue capture and integrity areas.
The primary purpose of this role is to achieve complete patient net revenue realization and minimize revenue leakage across the system. This involves complete capture of patient revenue in line of business, denials prevention, auditing accounts to support accurate revenue capture and eliminate leakage, oversight of related EHR updates, feedback and training to clinical departments, Strategic Pricing, data analytics, denials prevention, DNB management, collaboration with departments impacting the flow of revenue, and any related functions to accomplish the purpose of the role.
UW Medicine is a complex Academic & Safetynet organization comprised of 7 entities, including: UW Medical Center (UWMC), Harborview Medical Center (HMC), Valley Medical Center (VMC), Airlift Northwest, UW School of Medicine (SOM), UW Physicians (UWP), and UW Neighborhood Clinics (UWNC). UW Medicine also has strategic partnerships with Fred Hutch Cancer Center (FHCC) and Seattle Children's Hospital.
The position requires cross-functional collaboration with key areas across UW Medicine, including (but not limited to): Information Technology, Clinical Operations, UW Physicians, Finance, Payer Contracting, Supply Chain and Pharmacy.
UW Medicine operates in a complex business and technical environment, which is innovative and dynamic, with a high degree of ambiguity. A successful candidate must embrace this environment and be able to function at a high level within that context.
DUTIES INCLUDE: (but are not limited to)
REGULATORY COMPLIANCE AND EDUCATION
Serves as the organizations leading authority regarding reimbursement issues and communicates CDM changes to the hospital departments and administration, patient accounting and others who are impacted by the change.
STRATEGIC PRICING AND CDM
Accountable to lead UW Medicine Strategic Revenue Integrity Oversight Committee comprised of selected executive committee members, whereby communication and dialogue occurs regarding changes in coding, regulatory and compliance issues as necessary to update and maintain pricing within the CDM
REVENUE INTEGRITY (CHARGE CAPTURE & AUDIT)
Works directly or indirectly with Hospital Finance and other areas to provide data, reports, assistance with projects or audits, to correct problems or enhance services.
Oversee ERC data analytics and KPI performance monitoring, variance identification, related investigations and communication to appropriate stakeholders.
Optimize and manage Epic HB workque and charge router rules and CCI edits to facilitate compliant and accurate charge throughput.
LEADERSHIP / SUPERVISORY DUTIES
Supervises and provides oversight and direction to Managers, extended team, special projects analysts, and consultants as necessary to support Revenue Integrity functions
Develop effective relationships among internal/external stakeholders, colleagues and staff in order to build trust and lead individuals/teams through change initiatives.
Form detailed project plans, develop scope of projects, identify and collaborate with necessary internal/external stakeholders to ensure successful projects are executed among affected areas.
Creative problem solving through documentation of process improvement initiatives, and/or internal reporting mechanisms.
Develop appropriate budget for assigned projects or program initiatives.
Requirements:
Bachelor's Degree in business, finance, healthcare or a related field
10 years of leadership experience in a complex academic, research, healthcare or governmental setting, or an equivalent combination of education and work experience.
Demonstrated working knowledge of all processes surrounding Revenue Cycle Operations in a healthcare environment, including both hospital and physician settings.
Demonstrated proficiency with APC/APG reimbursement, CMS rules and regulations, coding, billing, and compliance
Proficiency with financial, billing and reimbursement data & analytics
Excellent communication and interpersonal skills, both verbally and in writing, with employees, medical staff, board members and external parties; strong presentation skills.
Experience with CDM/Charge Capture management in hospital setting or consulting role
A skilled communicator with an ability to create a collaborative work environment with multiple stakeholders across non-co-located entities is highly preferred.
DESIRED
Advanced degree in business, finance or a healthcare related field (strongly preferred)
Registered Nurse (RN)
Registered Health Information Administrator (RHIA) or Registered, Health Information Technician (RHIT) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
CONDITIONS OF EMPLOYMENT
UW Medicine Enterprise Revenue Cycle manages a significant volume of business and operations across multiple locations.
Work priorities shift in response to fluctuating demands.
Full time schedules are assumed to be at least 40 hours, however, incumbents are expected to remain flexible to accommodate the unit's goals and mission, and to work beyond their normal schedule when necessary.
While this role will primarily be based in an office environment, there will be exposure to clinical areas and operations.
Ability to provide transportation to travel as required to accomplish the goals of the unit.