Associate Vice President, Revenue Integrity

Job Number 54017
Posted 6/29/2018
Account EMHS
Department Revenue Cycle
Location EMHS - Cumberland Place, Bangor, ME 04401
Schedule Regular Full-time
Shift Day
Hours 8-430
Job Details SUMMARY
Reporting to the VP of Revenue Cycle of Eastern Maine Healthcare Systems, this position is responsible for providing leadership for all activities related to the management of EMHS's Revenue Integrity function. The AVP of Revenue Integrity sets the strategic direction for all of EMHS's hospitals, affiliates, physician services and ancillary services for the Revenue Integrity function. The AVP of Revenue Integrity is responsible for providing direction and leadership to achieve ongoing operational quality, productivity and efficiency in the Revenue Integrity department, both with the hospitals and physician practices. The AVP is responsible for planning, directing and overseeing the performance of the functional areas that report to this position including the development and maintenance of the enterprise Standard CDM, maintaining all of the EMHS' CDMs, associated electronic and paper-based charge capture vehicles and pricing activities. Primary areas of focus include operational oversight of the Revenue Integrity Department and managing the team charged with maintaining the overall charge structure for CDMs at all hospitals and hospitals within the Eastern Maine Healthcare System.


· Setting the strategic direction for the EMHS Revenue Integrity function

Participate on revenue cycle leadership team overseeing key operational and financial decisions pertaining to the RI revenue cycle

· Participate in various IT-related steering committees for information technology changes which affect the Revenue Integrity area and lead project groups as assigned

· Provides management oversight for charge development processes, and regulatory updates/requirements.

· Understands financial management and health care reporting, including the relationship between the CDM, charging, coding and billing.

· Oversees the review process of CDMs across the organization and sets accuracy standards for CPT and HCPCs codes.

· Works with leadership and managed care contracting to apply the pricing methodology, analysis, and validation for all hospital departments, clinics and physician practices.

· Understands each department's charging practices based on the CDM and oversees charge capture and reconciliation education for new services added.

· Demonstrates knowledge of various payment and coding systems, particularly the Outpatient Prospective Payment System (OPPS), DGR's, Medicaid APG Grouper, HCPCS and CPT-4 coding schemas.

· Understands charging processes and compliance issues, and the ability to provide resolutions by performing internet research, utilizing third party payer regulations, referencing coding guidelines, and utilizing local Fiscal Intermediary and CMS guidelines.

· Develops, implements, and manages efficient and effective operational policies, processes and performance monitoring across all functions of the Revenue Integrity Department.

· Ensures Revenue Integrity staff across all functions (CDM Maintenance, Charge Integrity, and Regulatory Updates) comply with established policies, processes, and quality assurance programs.

· Ensures two-way communication with Revenue Integrity staff and Revenue Cycle and hospital leadership.

· Partners with other operational areas and leaders within the health system to implement strategies designed to improve the effectiveness of Revenue Integrity processes through increased automation and controls.

· Directs and coordinates communication with Information Technology to ensure appropriate systems, enhancements, and tools are utilized to effectively manage day to day Revenue Integrity operations.

· Evaluates purchases, contracts and services provided by external vendors to ensure best pricing and effective results (external vendors, reference tools, software tools, etc.), including ongoing vendor performance monitoring and issue resolution.

· Maintains knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Revenue Integrity functions. Develops effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans. Seeks advice and guidance as necessary to ensure proper understanding.

Budget Responsibility

· Administers expense budget for department

· Presents departmental budget recommendations to VP of Revenue Cycle for approval

· Monitors budget performance and variance explanations

· Optimizes vendor relationships as necessary

· Evaluates current and new technology solutions

Authority / Decision Making Level

· Prioritizes and organizes work within division to meet changing priorities

· Reviews and approves policies and procedures for the RI, revenue cycle department for the hospitals as well as the related policies and procedures for the physician practices.

Supervisory Responsibility

· Directs activities of staff Directors and Managers that oversee all aspects of Revenue Integrity

· Provides leadership to direct reports and develops them into strategic thinkers and leaders across the organization

· Manages direct reports and has responsibility for hiring, firing, performance management and results of the assigned area

· Authorizes PEP requests for direct reports

· Approves initiation of disciplinary proceedings for staff, in consultation with Human Resources


· Provides strategic vision and direction to effectively manage industry shifts, regulatory changes, and rising cost pressures relating to RI revenue cycle functions

· Evaluates, monitors and assists in developing the priorities and progress of the Revenue Integrity Department

· Provides senior leadership with information regarding receivable impacts and/or departmental performance

· Through management and staff, implements improvements in work process that both improve the efficiency and effectiveness of revenue integrity

· Leads redesign initiatives and other EMHS-sponsored initiatives as requested

· Designs easily understood and impactful managerial reports for wide distribution

· Working with management staff, monitors payer and vendor activities and communications

· Stresses attention to detail and designs monitoring tools to ensure accuracy

· Identifies opportunities for improved efficiency through better processes and additional automation. Monitors impact of process-oriented changes on staffing requirements

· Coordinates and collaborates with key functions outside of Revenue Integrity Services to ensure strategic alignment with broader organizational goals and objectives

· Serves as an organizational sponsor for implementation of any software applications or technology enablers that improve the overall functionality of Revenue Integrity Services.

· Functions effectively in a Matrix Management environment


· Leads strategically through empowering staff and developing direct reports

· Demonstrates leadership and commitment to staff and colleagues by accepting accountability for outcomes, sharing timely information, building effective relationships and communicating clearly and directly

· Ensures adequate training is being provided to staff to educate on the following skills: current working knowledge of payer requirements; sufficient healthcare knowledge necessary to perform job requirements; knowledge of state, local and federal policy requirements for functions performed; and relevant knowledge of information technologies

· Leads and coordinates ongoing staff evaluation, retention, training and management of policies and procedures

· Manages and oversees staff performance through performance planning, coaching and performance appraisals

· Oversees and ensures two-way communication with Revenue Integrity staff and Revenue Cycle and hospital leadership


· Develops, implements, and manages efficient and effective operational policies, processes and performance monitoring across all functions of the Revenue Cycle Department

· Ensures Revenue Integrity Services staff comply with established policies, processes, and quality assurance programs

· Provides ongoing feedback loop communication to other Revenue Cycle areas

· Develops, implements, and manages efficient and effective operational policies, processes and performance monitoring across all Revenue Cycle functions

· Oversees and coordinates strategic pricing analysis to ensure optimal charging, coding and pricing has been established. Identify issues, communicate findings to Revenue Cycle stakeholders, define solutions and initiate resolution

Performance Monitoring

· Measures and reports ongoing financial and operational performance of the Revenue Integrity department. Recognizes areas of excellence and oversee the development and implement action plans related to functional areas where performance is not meeting expectations

· Manages/communicates the department dashboard and design action plans as issues are identified within the unit

· Ensures that key performance metrics are met on a monthly basis


Experience & Education

•Bachelor's Degree is required, preferably in the field of business, finance, healthcare administration, management or related field. A Bachelor's Degree in an unrelated field along with experience that commensurate the knowledge and skills needed to perform the role will be considered.

•Master level degree is preferred. 5 years of experience in a related field with a minimum of three of those years in a management capacity.

•Prior work experience should include a role in a redesign project.

•Experienced in using team building to positively influence the work environment.


· Significant understanding of healthcare business and finance principles, with special emphasis on hospital and physician access services

· Strong organizational skills, working effectively in a multi-task environment

· Demonstrated proficiency in written and verbal communication skills

· Demonstrated ability in leadership

· Ability to relate cooperatively and constructively with clients, co-workers, administration, other clinic departments, providers, community agencies, and other health team members

· Ability to work in a fast paced environment and remain flexible under stressful situations

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.