Senior Director, Revenue Cycle

23 hours ago

San Diego CA United States Scripps Health Full time

At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation's Top 100 Places to Work. You'll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you're open to change, go ahead and unlock your potential.


Join Scripps as Senior Director, Revenue Cycle where you will have primary accountability for the oversight of Coding, Clinical Documentation Integrity (CDI) and Health Information Management (HIM). The Senior Director manages the staff responsible for hospital and professional fee coding and CDI, ensuring quality documentation and clinical consistency.


This individual position is responsible for a diverse department, requiring skills in data-driven decision-making, process improvement/lean management, and customer relationship management.


The ideal candidate will possess a deep knowledge of industry best practices in technology and workflow. The Senior Director will use these skills and experience to partner with stakeholders to develop an organization-level roadmap of process and technology improvements to reduce provider burden and maximize patient experience while increasing efficiency. This position is responsible for the strategic direction of HIM across the health system centered on improved accuracy and efficiency.


Primary job duties include:
  1. Develop policies and procedures across the system for greater efficiency, reduced variation and increased patient satisfaction.
  2. Promote point-of-service (POS) tools, techniques, and measurements.
  3. Enhance centralized business office to reduce errors and facility costs.
  4. Serve as key participant in the design, implementation, and support of IS Core systems.
  5. Optimize hospital patient revenue.
  6. Oversee and lead system hospital and professional fee coding and clinical documentation integrity (CDI).
  7. Participate in formulating objectives and strategies for integrating coded clinical information to support goals for patient care, teaching, research and optimizing management of resources.
  8. Act as a coding subject matter expert for the system, serving on an array of business operations and clinical committees.
  9. Manage active daily management of Discharged Not Billed (DNB) work queues to assure targets are consistently met.
  10. Ensure appropriate staffing levels and adherence to fiscal targets.
  11. Develop and manage key coding and CDI performance indicators and metrics.
  12. Oversee a comprehensive quality assurance and productivity program for coding and CDI staff.
  13. Collaborate with physician and operational leadership to optimize workflows and technology.
  14. Demonstrate in-depth working knowledge of ICD, CPT, MS-DRGs and APR-DRGs code classifications/groupers with the ability to analyze and trend key metrics including CMI.
  15. Manage quality standards for the area and oversee quality validation on first listed diagnoses, secondary diagnoses, E&M levels, and Hierarchical Condition Categories (HCCs) for accuracy and compliance as relates to Outpatient CDI. Monitor Risk Adjustment Factor (RAF) Scores.
  16. Direct instructions and education activities for all Outpatient providers and ancillary staff across the system, in collaboration with clinic managers, CDI Educators, Physician Advisors, and coding departments, on coding and documentation related issues. Promote compliance with CMS, third party payers, NCDs and LCDs, coding, and billing regulations. Oversee the development and coordination of ongoing CDI education for new staff, including physicians, coders, nurses, and allied health professionals.
  17. Manage and provide oversight of the Clinical Documentation Integrity Program to ensure optimal documentation and program effectiveness.
  18. Direct and oversee coding/abstracting activities in accordance with policies and procedures, external agency requirements, AHA's Coding Clinic and other relevant industry standard guidelines.
  19. Provide input to coding and medical record documentation guidelines to assure compatibility and compliance with all regulatory, third party and organization policies.
  20. Guide the establishment and maintenance of documentation standards and policies and procedures related to coding and CDI activities.
  21. Oversee and manage coding denial management activities.
  22. Communicate clearly, proactively, and concisely with all key stakeholders.

This Director position is eligible to participate in the Director Incentive Plan.


Position is located in La Jolla and does require residence in San Diego.


The following are not eligible for hiring incentives:

  • Internal candidates
  • Rehires that left Scripps less than 3 years ago

In order to remain eligible for your retention incentive the following criteria must be met:

  • Must remain in original hired FTE Status and Shift (if specified in offer letter)
  • Must remain in original department/specialty
  • Must remain in original Job Title
  • Transfers to other locations will be reviewed on a case-by-case basis and may result in forfeiting remaining incentive bonus unless specifically noted in your offer letter.

Qualifications

Required Education/Experience/Specialized Skills:

  • Bachelors of Science or Arts
  • 5 years of healthcare admitting registration/finance/patient accounting plus 5 years of progressive level of multi-hospital system management responsibility including operations redesign and project management.
  • Knowledge of Federal/State/County/Commercial Insurance Payers requirements.

Preferred Education/Experience/Specialized Skills/Certification:

  • Masters in Business, Healthcare Administration, and Finance preferred.
  • EPIC system experience
  • 3M 360 Solution
  • AHIMA RHIA (Registered Health Information Administrator)
  • AHIMA RHIT (Registered Health Information Technician)
  • AHIMA CCS (Certified Coding Specialist) or AAPC CPC (Certified Professional Coder)
  • Knowledge of ICD and/or CPT/HCPCS coding
  • Strong analytical, assessment and critical-thinking skills.
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