Description

:The Middle Revenue Services Director provides system leadership, education, and strategic direction for Clinical Documentation Integrity, Physician & APP Advisory and Utilization Management teams. Ensures quality of care meets or exceeds regulatory standards. The Director acts as the liaison to clinical practices and clinicians by providing education and support to better understand documentation and coding guidelines, regulatory/payer requirements and the relationship between documentation, the code assigned, and the effect on compliance, quality, population health initiatives and reimbursement. Education Qualifications:

Key Responsibilities: Designs, implements, and oversees Essentia Health utilization management and clinical documentation integrity (CDI) programs for inpatients and outpatients across all markets Manages operational budget and strategic initiatives Develops, implements, monitors, and drives necessary standards and measurements by establishing key performance indicators (KPIs) internally and measuring against external best practices to ensure optimal outcomes Drives revenue enhancement and cost controls/reduction efforts to achieve Revenue Services fiscal year operational goals Collaborates with regional and site-specific executive leadership to implement and oversee a concurrent Utilization Management (UM) and Clinical Documentation Integrity (CDI) program Builds strong partnerships with internal teams, external consultants, and physicians to drive achievement of UM and CDI goals and performance metrics Works closely with leaders in revenue cycle services, population health, quality, and case management to support and advance organizational strategies and priorities Education Requirements: Bachelor’s degree in nursing, health information management, business, accounting, finance, or a related field of study Required Qualifications: 8 years’ experience in Clinical Documentation or Utilization Management or related field 3 years’ experience in leadership of Clinical Documentation or Utilization Management program Preferred Qualifications: Proven experience within integrated healthcare systems Proficient in Epic, 3M Encoder, Clinical Documentation Integrity (CDI), and Computer-Assisted Coding (CAC) platforms Holds a master’s degree in nursing, health information management, business, accounting, finance, or a related discipline Comprehensive understanding of coding and reimbursement methodologies, including ICD-10-CM/PCS, DRG models, Severity of Illness (SOI), Risk of Mortality (ROM), Value-Based Purchasing (VBP), CPT, HCPCS, APC/APG/EAPG, and Hierarchical Condition Categories (HCCs) Demonstrated expertise in hospital-based electronic health record (EHR) systems, regulatory compliance, coding guidelines, and agency requirements

Licensure/Certification Qualifications:

Registered Health Information Administrator (RHIA) or Registered Nurse (RN) Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) credential FTE:

1 Possible Remote/Hybrid Option: Remote Shift Rotation:

Day Rotation (United States of America) Shift Start Time:

Shift End Time:

Weekends:

Holidays:

No Call Obligation:

No Union:

Union Posting Deadline:

Compensation Range: $119, - $178, Employee Benefits at Essentia Health: