Director, Corporate Finance (Revenue Integrity Operations)

Job Description

The Director, Corporate Finance (RIO) promotes the financial viability of Northwell Health by effectively managing the organization's revenue capture operations. The Director works in close partnership with many aspects of the organization and is central to creating a comprehensive and seamless revenue cycle throughout Northwell Health. In addition, the director plays a key role as a subject matter expert in hospital coding accuracy and regulatory compliance.

Job Responsibility

• Leads a Corporate Finance group by communicating with, developing, and training staff, and building consensus for programs and goals that support a business, function, or geographic area.
• Develops and articulates a short-term strategic vision for areas of responsibility.
• Monitors, evaluates, and implements policies and procedures to improve the efficiency of current systems/operations/processes/functions.
• Evaluates, develops, and implements quality management and performance improvement programs.
• Ensures financial operations and programs are compliant and consistent with the regulatory and fiscal environment including but not limited to; federal, state, and local laws and accrediting regulatory agencies.
• Ensures all applicable financial processes and controls are routinely completed and compliant with department policies.
• Implements programs and initiatives to achieve the mission, vision, and goals of the organization.
• Manages and evaluates direct reports and oversees the management and evaluation of indirect reports.
• Manages budgeted resources, materials, technology, and human resources.
• Ensures compliance with applicable laws, regulatory standards, and internal policies.
• Develops and articulates a short-term (6 months -1 year) strategic vision for areas of responsibility
• Identifies opportunities to initiate operational change within department(s)
• Leads a functional unit in multiple sites by developing, communicating, and building consensus for goals/programs that support business or region
• Acts independently to uncover and resolve issues associated with the development and implementation of operational programs
• Regularly collaborates work with senior to executive leadership and those outside clinical and/or business areas
• Acts as an advisor to leadership on the development of overall policy and mid to long-term goals of function units
• Direct reports must be at the Professional leveling guide or higher
• Prepares budget and recommends for approval
• Responsible for day-to-day management of budget for departments
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act.

Revenue Integrity Operations Responsibilities

• Maintains the hospital's charge description master (CDM) by incorporating new charges/services requested by revenue generating departments in addition to required action in response to third party changes, CMS special requirement and coding updates. Directs the monitoring and approval of changes made to the hospital's charge description master.
• Oversees and assists in the resolution of Medicare / Medicaid edits generated on hospital outpatient and inpatient Part B claims.
• Works collaboratively with the revenue producing departments and HIM to ensure all charges and coding are being captured and supported by documentation.
• Educates hospital departments with respect to the use and maintenance of the charge master and charging philosophy.
• Ensures timely review of regulatory literature such as the Federal Register, Medicare Newsletters, National and Local Coverage Determination policies, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting Northwell Health's CDM and charge capture systems.
• Serves as a resource for Medicare and Medicaid reimbursement methodologies including APC's, APG's.
• Educates and ensures billing compliance of various Medicaid programs including OASAS, OMH, School Based Clinics and Dental.
• Ensures that the codes contained in the CDM are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
• Ensures the on-going accuracy and integrity of the CDM by ensuring that all charges are communicated and coordinated with the performing departments to implement necessary changes to charge documents, charge capture process, and order entry procedures.
• Identifies services that are billable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes as appropriate. Determines charge attributes for new services and products and ensuring that a viable charge capture process is developed and implemented.
• Participate in various IT-related projects which affect the revenue cycle and leads planning initiatives for revenue cycle IT related enhancements.
• Plans and schedules audits of selected hospital departments; compares medical records against claim to ensure optimum and appropriate charge capture and coding accuracy.
• Leads CDM departmental reviews in conjunction with hospital department staff and clinicians involving line item review and standardization.
• Involved in external vendor selection that provide revenue integrity CDM and claims analysis products and services.

Job Qualification

• Bachelor's Degree required.
• 8-12 years of relevant experience and 7+ years of leadership/management experience, required.

Preferred Qualifications

• Coding Credential(s) required from the American Academy of Professional Coders (CPC, COC, CIRCC) and/or American Health Information Management Association (CCS, CCS-P)
• Advanced hospital outpatient medical coding experience (minimum 8 years) and 5+ years of leadership/management experience
• Experience in interpreting regulatory documents such as the Federal Register as it relates to the Outpatient Prospective Payment System (OPPS)
• Extensive knowledge in Medicare and Medicaid reimbursement methodologies

*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).