Description
The Senior Director of Clinical Revenue Integrity directs and oversees clinical revenue integrity processes, practices, and operations for all hospitals at the Health System level. The Senior Director will serve as the Health System primary subject matter expert, managing a shared-service model among multiple hospitals. In addition, the Senior Director uses charging and regulation expertise to perform daily operational management of the CRI program and staff. This position evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that CRI processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility charges for compliant billing practices. This Senior Director has complete oversight and/or coordination of all charge capture and revenue integrity activities including, but not limited to regulatory compliance audits, charge integrity assessments, charge description master reviews, and other operations support activities for the health system. The Senior Director also acts as a liaison between the clinical and operational leadership to drive accurate charge capture. This position will have a specific focus on revenue integrity teams with the goal to enhance effectiveness of patient net revenue realization and minimize revenue leakage across the system. This involves complete capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations. This position reports to the Vice President of HIM and Revenue Integrity.
Essential Duties:
- Provides management oversight of all charge capture and revenue integrity activities assuring accurate and complete CDM is available for charge capture throughout the hospital system.
- Provides leadership, feedback, coaching, counseling, guidance, and direction on management of Revenue Integrity Operations (account and claim edit management), missing charges, charge trigger methodology, CDM, fee schedules and charge capture.
- Utilizes knowledge of federal and state regulations to ensure compliance.
- Responsible for multi-hospital system development, implementation and maintenance of internal controls and policies to maintain sound clinical revenue integrity practices.
- Directs and facilitates the development of corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration.
- Establishes best practice protocols and highest quality outcomes throughout the hospital system, while also ensuring consistency.
- Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Registers, fraud alerts, OIG advisory opinions and other relevant publications.
- Works collaboratively with numerous other system leaders in developing and implementing systems and processes to support revenue integrity process addressing, but not limited to, charge capture accuracy, reconciliation and late charge management.
- Develops and maintains collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue.
- Investigates and advises on matters relating to technical or regulatory requirements for charge capture activities.
- Communicates performance opportunities/issues to inform management and staff at all levels; motivates and incentivizes; instills accountability; monitors productivity and quality of work; and provides technical training and leadership development courses pertinent to service line.
- Completes and engages in employee performance reviews, addresses performance issues, councils, and terminates (as needed).
- Leads and conducts focused charge capture and coding audits system-wide on various topics and compliance aspects.
- Develops and enforces productivity and quality standards and monitors multi-department performance.
- Responsible for hiring, training, and the development staff.
- Maintains a working knowledge of current laws, regulations, health system policies and standards, industry best practices to implement system-wide goals and standards.
- Provides support to departments and operational charge reconciliation and late charge management.
- Supports and facilitates with the CDM pricing review in alignment with USC Finance and Reimbursement policies and guidelines.
- Performs other duties as assigned.
Required Qualifications:
- Req Bachelor's Degree In Finance, Business, Health Care Administration, Health Information, or Nursing.
- Req 7 years Experience in a related field or equivalent experience in revenue cycle operations or with CPT/HCPCS coding in a health care management environment.
- Req 3-5 years Of progressive management/ leadership experience.
- Req Experience in healthcare with a progressive focus on charge to payment relationship and patient account functions and understanding of health care financing and reimbursement mechanisms along with management.
- Req Must have the ability to plan, develop, and present educational or programmatic materials in front of an audience ranging from 1:1 to 1:20.
- Req Ability to work remotely utilizing technology for meeting and employee engagement
- Req Strong organizational skills to keep track of multiple priorities of highly detailed information.
- Req Strong executive presence, including communication skills that enable appreciation of others' perspectives and the ability to offer compelling insights and recommendations.
- Req Strong quantitative, analytic, and problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions.
- Req Demonstrated knowledge of the content, structure and maintenance of the Charge master and fee schedule.
- Req Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements in the facility to include DRGs, APCs, Medical necessity.
- Req Process strong understanding regarding billing documents and data fields for the UB04.
- Req Strong business acumen.
- Req Excellent decision and analytical skills
- Req Excellent communication skills, both written and verbal
- Req Effective problem solving
- Req Ability to lead and build remote-based teams effectively and collaboratively
- Req Knowledge of industry and regulatory program policies, procedures, and laws.
- Req Stong Excel skills
Preferred Qualifications:
- Pref Master's degree In Finance, Business, Health Care Administration, Health Information, or Nursing.
- Pref Cerner experience
Required Licenses/Certifications:
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date (applicable to employees working within City of LA).
- Req Certification in at least one of the following: *CPC, CCS, CCS-P. Must obtain within six (6) months of hire if not certified at time of hire.
The annual base salary range for this position is $158,080.00 - $260,832.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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