Director of Revenue Integrity

At Discovery Behavioral Health, we know the best way to predict the future of healthcare is to create it.  As a member of our growing team, you will have a voice in the creation of life-changing programs and treatment centers nationwide.  Working collaboratively with the best and the brightest in our industry, you will be part of an innovative team of professionals committed to generating positive and remarkable outcomes for the clients we serve. If you are looking for an organization that thrives on growth, celebrates diversity of thought, and rewards passionate execution, you’ve come to the right place.  Because we put clients first, it is our honor to support and reward those who serve them.

If you are looking for an organization that thrives on growth, celebrates diversity of thought, and rewards passionate execution, you’ve come to the right place.  Because we put clients first, it is our honor to support and reward those who serve them. 

Compensation Range: $140-150k per year.

Compensation will be dependent upon geographic region, education, and experience

The Director of Revenue Integrity will be responsible for assisting with revenue cycle performance improvement initiatives across Discovery Behavioral Health. The individual must possess knowledge of billing and coding regulations along with payor specific guidelines.

This individual will work collaboratively with the Vice President of Revenue Cycle, with functional directors across revenue cycle and other cross functional teams to ensure all third party payor issues, including but not limited to denials and underpayments are resolved so DBH receives proper reimbursement. In addition to ensuring the highest level of efficiency, integrity, and compliance with billing regulations, this individual must demonstrate a strong commitment to taking ownership of issues and facilitating effective outcomes in a timely manner. Possessing a strong understanding of system integration and revenue cycle will also be critical. Completing audits, determining corrective actions to be taken including educational opportunities when appropriate, and proactively communicating these activities to RCM leadership will also be critical.

Essential Job Functions:

Duties of the Director of Revenue Integrity will include, but not be limited to the following:

· Serve as the liaison with third-party payors to ensure claims are processed and followed up on to meet DBH’s RCM performance metrics and targets

· Utilizes multiple avenues as well as knowledge of medical billing and coding guidelines to prepare accounts for escalation and resolve insurance denials and underpayments in a timely manner while maintaining positive relationships/communication with insurance companies

· In collaboration with the Director of RCM Billing and Collections, manage the aging of accounts receivable by trending and analyzing A/R through communication with payors

· Prepares and submits escalation packages (i.e., reconsiderations and appeals) related to denials using payor documentation and portals

· Resolve out-of-network (OON) insurance underpayments through proven knowledge of revenue cycle

· Complete ongoing QA and analysis of underpayment areas to ensure accuracy, compliance with state and federal laws and regulations

· Monitors payor memos; communicates and meets regularly with RCM leadership team on trends identified

· Audits workflows to ensure data integrity and compliance of process guidelines

· Utilizes analytics to assist in supporting and monitoring appropriate billing, collection, and payment posting activities; works with appropriate personnel to help resolve issues identified

· Works closely with the RCM leadership team to ensure accuracy and consistency in processes, including policy and procedure and education development

· Identifies quick hits and re-design opportunities based on discussions, outcomes and process flow analysis and/or documentation reviews

· Communicates regularly with key stakeholders about progress, critical factors, and obstacles

· Continually works toward meeting DBH’s financial outcomes through improved processes

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. The individual in this position must possess the following qualifications:

  · Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field; Master’s degree preferred.

  · Minimum 5 years of progressive management experience in healthcare revenue cycle management

  · In-depth knowledge of healthcare billing, coding, reimbursement methodologies, and regulatory requirements (e.g., HIPAA, Medicare/Medicaid)

  · Strong analytical skills with the ability to interpret complex data, identify trends, and develop actionable insights.

  · Excellent communication, interpersonal, and leadership skills, with the ability to collaborate effectively across departments and influence stakeholders at all levels of the organization.

  · Self-starter with strong individual motivational skills

  · Highly dependable and able to meet internal deadlines consistently

  · Flexible and adaptable, willing and able to adjust to rapidly changing priorities

  · Ability to use Word, Excel, Powerpoint, and Visio at a minimum

We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, or national origin.

For more information about our company benefits, please visit us at discoverybehavioralhealth.com/careers/

Discovery Behavioral Health seeks to build a diverse staff that is reflective of the patients we serve and the communities where we work. DBH encourages multiple perspectives, experiences, and strives to hire and retain a diverse workforce.