Director of Revenue Integrity & Charge Optimization

Memorial Hermann Health System; Houston (TX); On-site; USD 150,000 - 230,000; Full time

Job summary

Memorial Hermann Health System seeks a Director of Professional Revenue Integrity to lead the department, drive process improvements, and assure compliant, timely charging across professional services. You will partner with MHMG and Revenue Cycle leadership to optimize coding, pricing, and reimbursement strategies.

The role requires 10+ years in physician/professional billing with 5+ years in a management capacity, and extensive EPIC Resolute Billing experience.

Qualifications

• Ten (10) years of Physician/Professional Billing experience with at least five (5) years in a management level position for a large health system required.
• Extensive knowledge and experience with Epic EMR system, specifically EPIC Resolute Billing.
• Experience in Charge Capture, Charge Reconciliation, Charge Pricing, Charge Routing, and Reimbursement.

Responsibilities

• Oversees all facets of professional services revenue integrity processes to achieve and exceed best practice benchmarks.
• Partners with senior leadership and Memorial Hermann Medical Group to establish and maintain industry-leading best practices for revenue integrity and coding.
• Enhances financial performance by implementing process improvements, optimizing charge capture and reconciliation, and maximizing revenue.
• Monitors governance of daily charge reconciliation procedures and engages departments in maintenance.
• Provides support and pricing methodology guidance through fee schedule maintenance.
• Advises Networking on payer trends and adjudication procedures as necessary.
• Promotes data-driven improvements from root cause denial analysis and system edits assessment.
• Develops strategy, goals, budgets, and performance standards for revenue integrity with growth focus.
• Delivers timely communication to stakeholders and participates in committees and project teams.
• Ensures compliance with HIPAA, regulations, and internal policies.

Skills

Leadership

Epic Revenue Integrity

Revenue Cycle

Charge Capture

Fee Schedule

Pricing Modeling

CPT Review

Workflow Mgmt

Process Improvement

Communication

Excel

Education

Bachelor’s degree in Healthcare Administration or related field

CPC

CMC

Epic ARCR Certification

PMP

Job description

Memorial Hermann Health System seeks a Director of Professional Revenue Integrity to lead the department, drive process improvements, and assure compliant, timely charging across professional services. You will partner with MHMG and Revenue Cycle leadership to optimize coding, pricing, and reimbursement strategies.

The role requires 10+ years in physician/professional billing with 5+ years in a management capacity, and extensive EPIC Resolute Billing experience.