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System Director Revenue Integrity - QA - Audits

Job ID: 104753 Date posted: September 10, 2020

  • Sharp HealthCare
  • PFS Billing & Collections
  • Executive Jobs
  • Day Job
  • Full-Time

Responsibilities

Summary:


The System Director of Revenue and HIM Integrity, Quality, and Audit is responsible for directing the development and execution of Revenue and Coding Integrity Programsacross the health care system. Directs Revenue and Coding Specialists to assess and improve the quality of registration, revenue and coding systems documentation to ensure compliance, reimbursement accuracy, and appropriate level of care and facilitate billing, coding and abstracting appropriately reflective of clinical and financial documentation in the patient record. The Director works closely with the Medical/Clinical Staff, Revenue Cycle, Health Information Management, Compliance and the Informatics teams to achieve financial, clinical and operational excellence.

Direct Reports include: Manager of Revenue Cycle Quality Assessment, Manager Training Development and Competencies, Manager Health Information Management Quality Assessment, Chargemaster Coordinator, RAC Coordinator, Supervisor of Denials Management, Financial Analysts.

Required Skills and Qualifications:

  • 5 years of progressive revenue cycle management in an integrated healthcare environment with experience in all phases of hospital revenue cycle.

  • 5 years oftechnical experience working with ADT/AR, EHR, coding and ancillary systems.


Key Responsibilities:

  • 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.

 

Skills, Knowledge 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)

 

Customers Served:

Revenue Cycle, Health Information Management, Compliance, Case Management, and Quality. Physicians, Physician Assistants, Nurse Practitioners, and other health care professionals.

 

Compensation and Benefits:

The position provides a very competitive compensation, including opportunity to participate in a system-wide incentive program along with a generous benefit package.

 

  “Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.”

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“After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it.”

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