Director Revenue Integrity

Central Maine Healthcare; Lewiston (ME); On-site; USD 120,000 - 180,000; Full time

Job summary

Central Maine Healthcare is seeking a Director Revenue Integrity to lead the Revenue Integrity department, guiding hospital and physician services and ensuring data accuracy across the revenue cycle. You will monitor process improvements, KPI outcomes, and policy adherence, collaborating with Finance and Compliance teams.

The role requires a strong background in healthcare finance, HIPAA/privacy, and experience driving outcomes in a complex health system.

Qualifications

• Master’s degree preferred; Bachelor’s degree required.
• Ten (10) years of experience in Finance or Revenue Cycle with a minimum of 5 years in leadership roles.

Responsibilities

• Provide strategic and operational leadership for Revenue Integrity.
• Monitor and improve the quality, timeliness, completeness, and accuracy of Revenue Integrity processes.
• Oversee data integrity and reporting of financial performance and KPI impact.
• Ensure effectiveness of Revenue Integrity policy, practices and technology platforms.

Skills

Leadership

HIPAA & Compliance

Data analytics

Financial acumen

Communication

Project management

Revenue cycle knowledge

Medical terminology

Education

Master’s degree (preferred)

Bachelor’s degree (required)

Tools

CPT/HCPCS

ICD-9/ICP-10

Job description

Overview

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

Responsibilities

The Director Revenue Integrity is responsible for strategic and operational leadership of the Revenue Integrity department. This position contributes to the financial strength, compliance and overall performance of Revenue Cycle operations by providing leadership for all Revenue Integrity functions, including hospital and physician (provider) services. The Director Revenue Integrity serves in a key role to monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of Revenue Integrity processes (such as charge master accuracy, charge compliance and accuracy, payment variance analytics and prevention and overall quality and accuracy of all data flowing through the revenue cycle). Data integrity and reporting of financial performance and impact of improvement initiatives and standard KPIs is required. The Director will ensure the effectiveness of Revenue Integrity policy, practices and technology platforms. Net revenue/performance improvement goal setting, monitoring and achievement are required. The Director Revenue Integrity reports directly to the Vice Presient of Revenue Cycle at Central Maine Healthcare.

Qualifications

• Master’s degree preferred, Bachelor’s degree required, and
• Ten (10) years of experience in Finance or Revenue Cycle with a minimum of 5 years of experience in leadership roles.

Knowledge, Skills, And Abilities

• Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
• Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
• Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
• Working knowledge of Medical Record, Financial Services and Healthcare Application technology.
• Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
• Able to effect collaborative alliances and promote teamwork.
• Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
• Effective organizational, planning, controlling, scheduling and project management abilities.
• Effective managerial and administrative abilities as applied to the management of multiple projects.
• Effective leadership abilities.
• Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.
• Ability to positively influence change.
• Excellent communications skills, both oral and written.
• Demonstrated ability to work well with diverse people, excellent human relation skills.
• Flexible and able to react to ever changing priorities.

Pay Transparency

Central Maine Healthcare Corporation offers competitive compensation and a reasonable compensation estimate for this role is $XX.XX to $XX.XX. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf