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UC San Diego Health · 21 hours ago

Director, Revenue Integrity - 137974

San Diego, CA

Full-time

Onsite

Director/Executive

$165K/yr - $245K/yr

8+ years exp

UC San Diego Health is a leading academic health system dedicated to delivering outstanding patient care and improving community health. The Director of Revenue Integrity is responsible for managing the organization's revenue capture operations, ensuring compliance and efficiency in billing and charge capture processes while collaborating with various departments to enhance financial viability.

Health Care

Responsibilities

Drives the implementation of programs, policies, initiatives, and tools for Charge Capture, including but not limited to institutional system-wide charge capture processes to ensure efficiency and effectiveness

Improvement of department processes and procedures to ensure timely and accurate capture of all chargeable activities

Development of action plan with responsible parties and due dates of issues identified

Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms

Development and maintenance of collaborative working relationships 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

Collaborates with Clinical Physician Leaders and Departments to review new technologies and establish related charge capture and coding protocols

Directs and facilitates the development of corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. This includes evaluation and identification of root causes resulting in charge capture deficiencies or lack of revenue recognition

Reviews revenue for potential system optimization/enhancements to ensure consistent charge capture, including revenue guardian rules, claim edits and DNBs to act as stop gap measures for revenue leakage

Develops and executes Charge Audit Approach identifying department(s) for review including chart documentation on a regular basis to verify the clinical documentation supports the charges billed, prepare a summary report of findings, and share with department leadership. Oversees CDM Annual Audit and Charge Capture Audit

Develops and monitors KPIs related to charging practices and reports metrics to revenue generating department leadership

Directs the design/redesign of CDM processes and systems to improve service and data integrity

Maintains oversight of Charge Master Development, working closely with Revenue Generating Clinical Departments to ensure that coding, revenue codes, description nomenclature patient billable vs. non-billable, catalog development and updates (add/delete/change) for all CDM items are appropriate, verified through monthly feedback from Executive Leadership

Ensures annual department CPT/HCPCS coding and CDM maintenance updates coincide with the CMS annual updates to the Hospital Outpatient Prospective Payment System

Reviews existing processes to ensure proper controls are in place for the maintenance and reconciliation of CDM updates utilizing CDM Manager

Ensure annual CDM Pricing is updated and implemented

Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication across the enterprise

Acts as a Subject Matter Expert for Revenue Integrity/Charge Capture and for professional and technical CDM related issues building strong relationships with the clinical departments

Monthly meeting with involved departments to address billing/charge-capture compliance concerns

Leads RI Operations meetings, steering committee, manager meetings and providers updates in other VP/C-level forums where appropriate

Monitors system reports and monitoring tools to track commercial and government payer denials and appeals related to revenue integrity for both hospital and physician revenue

Serves as managing leader when reporting on charge related denials, appeals, audit findings and coding variations

Analyzes weekly charge reconciliation and missing charge reports to verify that departments have captured all charges, and compile findings in departmental charge capture performance reports

Proactively identifies any charge trends and utilizes this information to determine focused reviews of specific departments. Provide education to staff based on findings

Maintains personal professional growth and development through seminars, workshops and professional affiliations

Establishes goals and objectives for each employee to measure performance and cross training to mutually agreed-upon expectations and provides employees with access to resources needed in progressing in their development plans

Ensures service and work quality to meet UCSD, state and federal rules and regulations. Utilizes work quality monitoring to ensure that policies and procedures, objectives, performance improvement, attendance, safety and environment, and infection control guidelines are followed

Adhere to current organizational Performance Improvement priorities

Participate in quality studies through data collection

Make recommendations and take actions to improve structure, system or outcomes

Ensures that compliance to rules, regulations, operations, contracts, internal and external rules, state and federal requirements are met

Follows established UCSD department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality

Qualification

Healthcare revenue cycleCharge capture processesCodingDocumentation standardsFinancial analysisCMS regulationsProblem resolutionBusiness planningCharge Audit ApproachCDM maintenanceRegulatory complianceLeadershipRelationship buildingProject management

Required

Bachelor's Degree in business, healthcare administration or related area and a minimum of eight or more years of directly relevant healthcare revenue cycle experience; OR equivalent combination of experience and education/training

Experience and proven success in knowledge of healthcare revenue cycle operations, concepts, and policies and their impact throughout the organization, with an in-depth understanding of related functions and issues, including coding and documentation standards, registration, billing and collection processes, reimbursements, aging accounts, contractual adjustments, and charge capture

Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development

Knowledge of CMS regulations, medical terminology and the various data elements associated with the UB-04 and CMS-1500 claim form

Knowledge of medical records, hospital bills, service item master and CDM

Knowledge of principles and practices of organization, administration, fiscal and personnel management

Thorough knowledge of local, state and federal regulatory requirements related to the functional area

Strong ability to provide leadership and influence others

Proven ability to mediate and resolve complex problems and issues

Ability to foster effective working relationships and build consensus

Ability to develop long-range business plans and strategy

Preferred

Advanced degree in business, finance or relevant field of study

Ten or more years of progressive revenue cycle experience, ideally within a large integrated health system

Progressive managerial/leadership experience. Ability to engage and mentor team members and subordinate managers/supervisors

Experience leading process improvement initiatives

Experience working for a consulting firm to drive process change in a multi-department environment

Experience developing a new department or function within an organization

Active certification as a Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P) from the American Health Information Management Association (AHIMA)

CHRI certification

Member in Healthcare Financial Management Association, the American Academy of Professional Coders and/or American Health Information Management Association