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Advisor shall develop expertise on matters regarding physician practice patterns, over and underutilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements. The Medical Director of Revenue integrity (Physician Advisor) is a key member of the healthcare organization's leadership team and is charged with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services.

ROLE SUMMARYThe Medical Director of Revenue integrity (Physician Advisor) is a key member of the healthcare organization's leadership team and is charged with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments, healthcare data team and the hospital leadership. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and underutilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.CORE RESPONSIBILITIES Provides functional leadership for the revenue integrity team, including CDI, Coding, and Utilization Review (UR). Oversees optimization of revenue integrity systems and operations. Chairs the Utilization Management (UM) Committee. Supports development, adoption, and utilization of value-based care initiatives. Reviews patient medical records identified by case managers or as requested by the healthcare team to perform quality and utilization oversight. Performs medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews. Provides regular feedback to physicians and other stakeholders regarding level of care, length of stay, and potential quality issues. Conducts Peer to Peer discussion with Payor Medical Directors when requested. Provides necessary clinical education to UR Case Managers regarding clinical criteria and appropriate us of screening tools. Educates individual hospital staff physicians about current ICD and DRG coding guidelines. Collaborates with CDI and coding team to develop complaint query practices, optimize review process, and provide necessary clinical support in DRG assignment as needed. Provides direct clinical support to CDI manager and RAC auditor for DRG level of care denials. Conducts physician education sessions to share data, trends, practice patterns, and other relevant information. Documents session outcomes and relevant information. Reports practice pattern trends and opportunities to service line or department specific meetings at the request of the CMO or hospital leadership. Supports payor contract process and physician contract process for quality measures. Participates in efforts to reduce inappropriate readmissions. Collaborates with Healthcare Data team to identify areas or processes contributing to excessive cost of care. Optimize service line revenues through proactive approaches and strategies. Participates in hospital committees to support and develop protocols related to evidence-based medicine and support optimal standards of care. Collaborates with the Chief Financial Officer to identify short term and long-term goals. The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified and employees may be required to perform other duties as assigned. KNOWLEDGE, SKILLS, AND ABILITIES Ability to drive strategic direction Knowledge of revenue cycle, clinical documentation, and payor relationships Ability to educate providers and stakeholders in a timely and effective manner Process improvement, quality improvement, planning, and decision-making skills Knowledge of regulatory requirements Advanced knowledge of patient safety principles, risk management, and strategies to minimize harm Ability to build rapport with stakeholders to obtain buy-in and collaboration towards goals Strong knowledge of Medicare Two Midnight rules Ability to interact respectfully with diverse cultural and socio-economic populationsMINIMUM REQUIREMENTS Hold and maintain or able to obtain an unrestricted medical license in the state of Wyoming.  Ten (10) or more years of healthcare and/or patient care experience Two (2) or more years of healthcare business, revenue cycle, utilization management, coding, clinical documentation improvement principals, or government/ regulatory value programs related experience Current American College of Physician Advisors (ACPA) membership 6 months (one of the following must be obtained within six (6) months of start date):  Current American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)certificate within six (6) months of start date Current American College of Physician Advisors Certification (ACPA-C) from the American College of Physician Advisors (ACPA) within six (6) months of start datePREFERRED QUALIFICATIONS Certified Medical Director (CMD) Medical billing, coding, or abstracting experience Internal Medicine experience with a background in Hospital Medicine InterQual experience MCG experience

Cheyenne Regional Health System

Medical Director of Revenue Integrity

Practice Match

_Directly supporting cCare, the largest private oncology practice in California, our experienced revenue cycle management specialists simplify and optimize the practice’s revenue cycle, from prior authorization through billing and collections._. Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue.

HOUR

_What Revenue Cycle Management (RCM) contributes to Cardinal Health_ Practice Operations Management oversees the business and administrative operations of a medical practice. Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero. _Directly supporting cCare, the largest private oncology practice in California, our experienced revenue cycle management specialists simplify and optimize the practice’s revenue cycle, from prior authorization through billing and collections._ The Lead – Pre-submission Billing Team is responsible for overseeing the daily operations of the billing team focused on pre-submission activities. This role ensures accurate and timely charge capture, supports denial prevention strategies, and drives performance through data analysis, team development, and process improvement. The Lead fosters a fast-paced, resolution-driven environment with a strong emphasis on communication, curiosity, and continuous learning. _Essential Functions_ + Monitor and manage daily billing workflows to ensure timely and accurate claim submission. + Organize and prioritize tasks across multiple practices, adapting to dynamic payer requirements and operational needs. + Provide guidance, coaching, and mentorship to billing staff to promote accountability and enthusiasm. + Support staff development through training, feedback, and performance monitoring. + Maintain department coverage and assist with scheduling and PTO coordination. + Analyze denial trends and AR reports using tools like Power BI to identify root causes and improvement opportunities. + Research CPT code denials against LCD/NCD requirements and payer policies. + Collaborate with cross-functional teams to implement clean claim strategies and reduce rework. + Serve as a liaison between billing staff, providers, and center leadership to resolve escalated issues. Communicate payer updates and industry changes to staff and leadership. + Participate in end-of-month closing procedures and support reporting deadlines. + Apply clinical knowledge in Oncology/Hematology, Radiation Oncology, and Urology billing. + Support documentation review and coding accuracy for complex services.Ensure adherence to standard operating procedures and compliance guidelines. _Qualifications_ + 6+ years of experience, preferred + High School Diploma, GED or technical certification in related field or equivalent experience, preferred + 4–8 years of experience in Revenue Cycle Management, preferably in a medical business office. + Bachelor’s degree in business administration, healthcare, or related field (or equivalent experience) preferred + Experience with computerized billing software and interpreting EOBs. + Familiarity with Urology, Chemotherapy, and Radiation billing. + Working knowledge of ICD-10, CPT, HCPCS coding standards. + Strong understanding of managed care contracts, Medicare, and Medicaid. + Preferred experience with GE Centricity and Power BI. + Strong organizational and analytical skills. + Excellent verbal and written communication. + Ability to manage multiple priorities in a fast-paced environment. + Customer service experience in a healthcare setting. Anticipated hourly range: $24.50 - $32.00 USD Hourly Bonus eligible: No Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with myFlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs Application window anticipated to close: 10/15/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (https://www.cardinalhealth.com/content/dam/corp/email/documents/corp/cardinal-health-online-application-privacy-policy.pdf)

Cardinal Health

Lead Coordinator, Revenue Cycle Management, Billing

Windham Professionals, Inc.

3. Works in all phases of provider enrollment, re-enrollment and expirables management ensuring the timely and accurate enrollment (and recredentialing) of providers in commercial and government payers. We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Job Description: Provides ongoing support and coordination as a liaison between the Medical Staff, Medical Directors, and Administration. The position directs the on-going credentialing / privileging process and other administrative functions for the Medical Staff, Medical Director, Administration, and Allied Health Professionals. Essential Functions + Participates in enrollment progress update meetings for assigned market. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators. + Completes all payer re-credentialing requests and demographic/roster requests. + Completes out-of-State Medicaid individual and facility enrollments timely and accurately for assigned States. + Participates in team work sessions for each market to address Epic hold and denial work queues and communicate issues and trends to leadership. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types. + Coordinates all aspects of provider enrollment with commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market. Ensures enrollment is completed timely and accurately. Follows-up with managed care organizations and government payers to ensure timely and accurate enrollment. Skills + Computer literacy + Microsoft Office + Communication (oral and written) + Organizational Skills + Attention to Detail + Accountability/ability to work independently + Customer Service + Knowledge of medical billing and collections + Medical terminology Job Essentials 1. Responsible for ensuring timely and accurate facility, medical group, and individual government enrollments for technical and professional fee claim reimbursement. 2. Coordinates all aspects of provider enrollment with Intermountain Health’s commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market. Ensures enrollment is completed timely and accurately. 3. Works in all phases of provider enrollment, re-enrollment and expirables management ensuring the timely and accurate enrollment (and recredentialing) of providers in commercial and government payers. 4. Accurate data entry of up to date expirables, practice/billing locations and other pertinent information to the payer enrollment database. 5. Participate in review, completion and/or submission of provider enrollment initial and re-enrollment applications for local and national commercial, Medicare, and Medicaid payers via payer online portals or other methods as applicable. 6. Follow up with payers via phone, website, or email requesting network participation and follow up on submitted applications. 7. Assist providers, and client personnel with completion of the application, routinely follow up with insurance carriers to monitor the status of applications and resolve issues. 8. Facilitate completion, set-up and/or re-attestations of CAQH applications. 9. Participates in enrollment progress update meetings for assigned market. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators. 10. Submits provider change and termination requests to all health plans in a timely manner. Informs commercial and government payers and internal Intermountain stakeholders of provider and clinic updates in assigned market. 11. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types. 12. Execute large enrollment provider/payer projects. Complete provider enrollment and related duties for organizational clinic acquisitions. Collaborates with Recruitment in the onboarding and off-boarding of providers. Minimum Requirements High School Diploma or Equivalent One year experience in a healthcare revenue cycle setting. Preferred Qualifications One year of experience working with governments payers and/or commercial payers in a revenue service setting. Demonstrated knowledge of working medical billing database work queues. Physical Requirements: Qualifications + High School graduate or equivalent is required + One (1) year previous work experience in healthcare + Preferred previous work experience in a revenue cycle setting + Preferred previous work experience with provider enrollment and/ or credentialing Physical Requirements + Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. + Frequent interactions verbally and written with providers, colleagues and leadership + Frequent computer use for typing, accessing needed information, etc. + Manual dexterity of hands and fingers. Location: Lake Park Building Work City: West Valley City Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $21.84 - $33.23 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) . Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.

Intermountain Health

Provider Enrollment Specialist

Intermountain Healthcare

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Medical Director of Revenue IntegrityCheyenne Regional Health System

Lead Coordinator, Revenue Cycle Management, BillingCardinal Health

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