Job Description:

Director, Revenue Integrity & Quality Assurance

Job Responsibilities:

Pilots teams with strong tactical decision-making and handling of unforeseen issues.

Impact --

- Develops new products, processes, standards, or business plans in support of the Function, Segment or Business Unit strategy.

- Establishes key elements of business plan with measurable contribution toward the achievement of results for the department; focus is on short-to mid-term results (e.g., 1 to 2 years).

- May have budget accountability for area of responsibility.

- Erroneous decisions or failure to achieve results have a moderate impact on the mid to long-term success of the function or division.

Complexity --

- Executes moderate to significant improvements to processes, systems, or products in order to enhance performance of discipline.

- Problems and issues faced are difficult to moderately complex, and require detailed information gathering and analysis.

Influence & Communication --

- Communicates regularly with parties within and outside of function. Frequently interacts with subordinate supervisors and functional peer groups. Periodically interacts with executives and senior stakeholders across the enterprise. Typically communicates with parties outside of the organization.

- May work to justify and gain cooperation of other parties on practices, policies and procedures. Sometimes requires ability to influence others outside of own job area on policies, practices and procedures.

- Approves hiring, firing, promotion, and reward decisions within area of responsibility.

Primary Responsibilities --

- Directs the design, planning, and implementation of Revenue Cycle Management (RCM) Revenue Integrity and quality assurance programs across the multiple locations and remote work-force that aligns with the objectives and strategy of the company.

- Maintains day-to-day oversight of the operational aspects of the Revenue Integrity Training and Quality Assurance teams; including, assistance with sampling design, tracking of team assignments, status reporting, dissemination, and archiving of documents, tracking of interdependencies between RCM and corporate education and training efforts, and of achievement of training plan deliverables.

- Manages and develops Revenue Integrity and Quality professionals.

- Manages as well as oversees Revenue Integrity projects and initiatives, developing standard work plans and monitoring results.

- Collaborates with functional management teams, as well as AR teams on Revenue Integrity projects.

- Directs, designs and manages the teams executing quality assurance reviews of insurance and denials management processes, claim and account detail; assuring quality, accuracy, timeliness and appropriateness standards are maintained and quality standards measured and achieved. Serves as subject matter expert about revenue cycle systems used in the business unit needed to ensure appropriate use and maximum efficiency. In addition, collaborates on the design of process, operational and system workflow monitoring/reviews to ensure that efficient, cost effective work processes are being executed.

- Directs and designs departmental report and scorecard and monitoring including benchmarks.

- Collaborates with vendor partners and AR management to calibrate quality reviews to ensure consistency and elevation in the evaluation of performance standards.

- Develops and maintains an effective communication protocol for notifying key staff when changes are made or need to be made to standard operating procedures and directives.

- This position may have potential responsibility for SOC-II Controls.

- This position may require knowledge of applicable data privacy practices and laws.

- This role may have access to sensitive data to include PII and ePHI.

Education:

Required:

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Bachelor's Degree (four year college or technical school) Required, Field of Study: Psychology, business administration, human resources management, organizational development or equivalent work experience.

Experience:

Required:

- 5 plus years of experience in Revenue Cycle Systems and Operations, or RCM Quality Assurance

- Requires broad management knowledge to lead project teams within a department.

- Typically requires extensive prior relevant experience.

- Report to Senior Director.

- Supervises 6-8 direct reports.

Knowledge, Skills & Abilities:

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Microsoft Office Products and on-line training tools

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Experience in building education curriculums and/or healthcare preferred, but not required.

Knowledge of and ability to identify what people need to learn for successful individual and organizational performance.
NextGen Healthcare believes in strength through diversity. We are an equal opportunity workplace and an affirmative action employer supporting Diversity, Disabled, and Protected Veterans. Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, gender identity, disability or veteran status.

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Because NextGen Healthcare believes in providing a safe work environment, we conduct background checks as part of our hiring processes.

Summary:

Directs the design, planning, and implementation of Revenue Cycle Management (RCM) revenue integrity and quality assurance programs across multiple locations and remote work-force that aligns with the objectives and strategy of the company.

1836 Lackland Hill Parkway, St. Louis, Missouri 63146
11350 McCormick Road Executive Plaza IV Suite 600, Hunt Valley, Maryland 21031
Remote Location, Any, 00000
Regular.

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