You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$79.420 - $102.480 - $125.540

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

Please Note: As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do
The System Director of Revenue Cycle, Quality, and Audit is responsible for directing the development and execution of Revenue Cycle including Billing, Quality and Audit Programs for professional revenue cycle across the health care system. Directs Revenue Operations, Quality and financial reporting teams to assess and improve the quality of registration, revenue and coding systems to ensure compliance, reimbursement accuracy, and denial management and reporting. clinical and finance. The System Director has operational oversight and responsibility for technology and software integrations that ensure billing compliance related to data claims submission, appeal and audit functions, clinic chargemasters, testing and implementation of both new IT functionality and IT enhancements The Director works closely with the Operational leaders at Clinics, Contracting, Managed Care Operations, and Compliance teams to achieve financial, clinical and operational excellence.

Direct Reports include Manager of Professional Revenue Cycle, Manager Accounts Receivable/Quality Control AR/QC, Denial Management, and Financial Analysts.


Required Qualifications

• 5 Years progressive revenue cycle management in an integrated healthcare environment with experience in all phases of hospital revenue cycle.
• 5 Years technical experience working with ADT/AR, EHR, coding and ancillary systems.

Other Qualification Requirements

• Bachelor’s degree in Business Administration or related required; or 4 years of experience in patient financial services required in lieu of degree.
• AHIMA ICD10 certification preferred.

Essential Functions

• Directs the staffing and training needs to meet expected requirements as defined for a highly reliable organization. Develops and implements an audit/education plan that uses feedback from audits to perform direct communications/trainings to impact future audit findings and continue the HRO path.
• Develops and manages the departmental budget.
• Works closely with members of the Health Information Management and Revenue Cycle staff and creates a support structure within each department for achieving operational excellence in relation to Health Information Management, Reimbursement, and Compliance.
• Responsible to ensure that systems, processes and reports are optimized so that data specific to each patient hospital encounter is accurately documented/coded/abstracted/billed/reimbursed. Shares finding accordingly with clinical and financial teams to support continuous quality improvement toward zero defect products.
• Directs and oversees the development of the education of all phases of the Revenue Cycle Process (To include Access, Insurance Verification, Record Coding Audits, Denials Management, Payer and Regulatory Appeals, and Chargemaster). Is accountable to work in a collegial manner with physicians, staff, and consultants.
• Creates and monitors system reports and utilizes monitoring tools to track the trending of both Commercial and Government Payer Denials and Appeals. Serves as managing leader when reporting hospital denials, appeals, audit findings, and coding variations. Reports findings to appropriate committees including Administration, Compliance, Revenue Integrity Steering Committee, Case Management, and Health Information Management.
• Develops and distributes report cards to appropriate key stake holders.
• Responsible for monitoring regulatory landscape and developing necessary guidelines, policies and procedures to ensure compliance. Ensures that department policies, procedures, and tools to monitor compliance with P&P’s are developed and deployed.
• Manages and reconciles systems with vendors to ensure full and accurate data reconciliation and data accuracy. Progressive Management (Bad Debt), MedeAnalytics, Craneware, Experian, Buonopane Group, etc.
• Provides oversight to all data requests and reports within the division produced by Financial Analysts. Presents daily, weekly, monthly, KPI’s in a platform appropriate for receiving area (dashboard vs. detail). Monitors and drives division direction toward high reliability in targeted areas (example: clean claim rate). Develops or coordinates with vendors tools for target achievement.
• Collaborates with interdisciplinary teams including, but not limited to, physicians, nurse practitioners and physician assistants, Physician Informaticists, Clinical Informaticists, Quality, Case Management, and Health Information Management. Collaborates and interfaces with entity administrative leadership, Chief Medical Officers, Medical Directors, Finance, and other members of the health care team to provide data and solution development processes. Promotes a strong collaborative working relationship with hospital revenue cycle and coding teams.
• Works with Information Technology Department to ensure electronic systems meet the needs of the revenue cycle and health care professionals. Assists with the coordination and communication of EMR system upgrades and changes related to revenue cycle, case management, documentation and coding. Recommends workflow and technical improvements to various electronic documentation and analytics tools.
• Review and design of processes that impact the revenue cycle across clinical and financial systems. Ensures that revenue integrity is established and preserved through all phases of system implementations, upgrades and maintenance. This includes creation, validation and reengineering of clinical and business workflows that result in revenue generation and documentation required to support claim submission.
• Drafts proposals and return on investment documents when recommending department budget increases for improved outcomes or efficiencies.
• Responsible for leadership oversight of hospital Chargemaster. Ensures that hospital departments receive support and are knowledgeable of department charges and compliance issues related to hospital billed. Ensures that OSHPD reporting requirements are met and that hospital CFO’s are supported when developing new service line offerings for purchase new equipment.
• In conjunction with senior leaders, sets short and long term goals for strategic progress towards success across the Sharp Pillars of Excellence. Makes decisions for accomplishment of objectives using data including: EMR goals; revenue and expense management; employee, patient and physician satisfaction.

Knowledge, Skills, and Abilities

• Extensive knowledge of treatment methodology, patient care assessment, data collection techniques and coding classification systems.
• Strong knowledge of Health Information Management, Patient Financial Services, Admission Discharge Transfer, and clinical workflows and processes.
• Strong knowledge of reimbursement systems, Medicare and Medicaid guidelines, federal, state, and payer-specific regulations and policies pertaining to documentation and coding.
• Strong knowledge of regulatory compliance in billing, collections, coding and abstracting.
• Proficiency in communicating clearly and effectively with multiple constituents.
• Proficiency with MS Office applications.
• Strong Knowledge of ICD10 and CAC (Computerized Assisted Coding).

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class