Director, Revenue Integrity, and Coding

Director, Revenue Integrity, and Coding

Under the direction of the Senior Director, Revenue Cycle at Harvard Medical Faculty Physicians (HMFP) at the Beth Israel Deaconess Medical Center (BIDMC), the Director, Revenue Integrity, and Coding will develop and implement HMFP's Revenue Integrity program for charge capture and charge reconciliation to ensure billing and coding compliance identifying any potential risk areas in professional revenue integrity and coding. Serve as regulatory resource for Medicare / Medicaid reimbursement and third-party billing rules and coverage through self-directed education and communication across the enterprise. Acts as a subject matter expert for revenue integrity, professional CDM related issues and professional coding to HMFP clinical service leaders for complex procedure areas as required. Responsible for the development of the annual plan, coordinating with BIDMC and HMFP compliance leadership, with an emphasis on maximizing revenue opportunity. The strategy will focus on physician education, monitoring changes in billing regulations to ensure compliance, responding to audit requests from insurance companies and the development of policies and procedures.

The following statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities and skills required for this position.

Primary Responsibilities :

• Directs and oversees HMFP's professional revenue integrity including CDM management, oversight of professional coding functions to ensure billing and regulatory compliance are met. Responsible for all compliance related matters, including remediation. Ensures charge capture revenue management opportunities and HMFP clinical service line specific reimbursement and revenue management is monitored.
• Champions standardization of charge capture and charge reconciliation processes.
• Works with HMFP clinical departments to address department processes and procedures to assure timely and accurate capture of all chargeable activities.
• Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms.
• Collaborates with clinical physician leaders and departments to review new technologies and establish related charge capture and coding protocols.
• Maintains oversight of charge master development, working closely with revenue generating clinical departments to ensure that coding, revenue codes, description nomenclature patient billable vs. non-billable, catalog development and updates for all CDM items are appropriate, verified through monthly feedback. Ensures annual department CPT / HCPCS coding and CDM maintenance updates coincide with the CMS annual updates to the hospital outpatient prospective payment system.
• Collaborates with HMFP clinical service line administrators and revenue integrity staff are performing charge reconciliation activities, following industry best practices, identifying and deploying charge capture improvement initiatives. Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, establish charge capture mechanisms, and orderly and timely recording of revenue.
• Monitors, proposes, and minimizes billing and coding inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials / appeals.
• Develops and executes charge audit approach identifying department(s) for review including chart documentation on a regular basis to verify the clinical documentation supports the charges billed, prepare a summary report of findings, and share with department leadership. Oversees CDM annual audit and charge capture and coding audits to ensure adherence to standards and enterprise-wide best practices by service line / specialty.
• Develops and implements corrective action plan based on audit findings and works with each of the clinical departments to meet established targets and adhere to best practices. Directs and facilitates corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. This includes evaluation and identification of root causes resulting in charge capture deficiencies or lack of revenue recognition.
• Monitors changes in coding regulations and communicates with clinical administrative leaders to ensure adherence to new policies.
• Works collaboratively with the HMFP compliance team, the HMFP clinical departments, and BIDMC to ensure adherence to established policies, government regulations and payor requirements.
• Directs and support managers with functional area responsibilities. Responsible for the development of staff including the following employment actions : hiring, termination, corrective action, and performance reviews. Direct Reports : 2-3

Required Qualifications :

About the Organization :

Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center (HMFP) is one of the largest physician organizations in New England, dedicated to excellence and innovation in patient care, education, and research. As a physician-led organization, HMFP partners with more than 2,400 providers to support the delivery of exceptional care, promote professional development, and foster balance at work and home. HMFP physicians have faculty affiliations with Harvard Medical School (HMS) and provide care throughout the Beth Israel Lahey Health (BILH) system and additional hospitals across Massachusetts. Our HMFP corporate staff provide comprehensive practice management services, such as compliance, legal, finance, and human resources to our faculty members.