Multi-Site Manager, Revenue Integrity

Found in: Talent US C2 - 2 weeks ago

Roseville, United States Adventist Health Full time

Job Summary:

Oversees the daily revenue integrity functions that support accurate charging and billing in compliance with state and federal regulations at the facilities within an Adventist Health system. Supports the implementation of system-wide standardization and facilitates long-term strategies to meet expanding and changing needs, in collaboration with operational and clinical leadership. Provides expert advice on charging/reimbursement aspects of growth initiatives. Assists in setting hospital and professional pricing strategies to include maintenance and develops and implements policies for the operations. Leverages automation for the technical charge description master (CDM) build within Cerner. Assures compliance, manages staff, supports department communication and education for charge capture related matters.

Job Requirements:

Education and Work Experience:

Bachelor's Degree or equivalent combination of education/experience: Required Master's Degree: Preferred Five years' healthcare revenue cycle experience: Preferred Application/technical work experience: Preferred One year leadership experience: Preferred

Licenses/Certifications:

Certification in Current Procedural Terminology (CPT) coding: Preferred

Essential Functions:

Supports the creation and implementation of policies for operations, programs, and all activities to achieve a compliant, standard charge master across the health system and/or market, as applicable. Ensures that processes and data meets standards established by the regulatory bodies and Adventist Health executive leadership. Leads team of revenue integrity specialists, CDM coordinators, charge capture associates, charge assurance nurse auditors, and reporting and data analysts across the system and/or market, as applicable. Drives continuous improvement in revenue integrity and chargemaster activities including the identification and implementation of applications and/or vendor partnerships which enhance operational performance. Supports annual review of the CDM. Manages ongoing maintenance to ensure a compliant and complete chargemaster for professional and facility charges. Leverages automation through electronic health record (EHR) and technology to streamline processes and maximize the effectiveness of the department. Ensures support to revenue cycle for change related denials and CDM adaptation for payer specific requirements. Supports all pricing strategies and pricing policies for Adventist Health, and ensures team follows established pricing guidelines. Manages tasks within the department to ensure charge codes and charge capture processes exist for all patient services, medications, and supplies. Requires strong communication and influencing skills with clinical leaders and IT staff to guide work performed in other areas of the organization. Compiles complex financial analysis to understand gross and net revenue implications of charging decisions and/or assess compliance issues. Reviews, monitors, and analyzes revenue performance and status on a regular basis to identify trends and strategize for continuous improvement and course correction. Supports strategic audits to identify opportunities to streamline charge capture processes and increase net revenue. Supports team on validating integrity of charges with ability to provide corrective action plans to remediate where necessary. Serves as the system and/or market's leading authority regarding reimbursement issues. Communicates status and potential issues to revenue integrity leadership and supports related organizational preparation initiatives including process and system changes, communication, education, and training. Provides training and education to clinical, clerical, and professional staff regarding accurate and appropriate charge capture and reconciliation. Ensures consistency in education, timely regulatory updates, and proper documentation standards and adherence to compliance initiatives. Monitors all areas for appropriate revenue capture via multiple layers of analytical tools and reports. Manages department communication and education of charge capture related workflows, including identified changes in processes, structures, or systems/functionality. Serves as a resource to system and/or market staff at all levels for questions regarding charging processes and resulting gross revenue. Supports development and manages distributions of system-wide charge capture compliance operational key performance indicators, to include establishing benchmarks and targets consistent with industry standards and best practices to track and trend performance and results. Ensures all federal and state regulatory requirements are met. Leads implementation of long-term strategies to meet the expanding and changing needs of the system and/or markets. Manages the timely preparation of all reports, assigning projects, maintaining completion schedules, and following up as appropriate. Documents results of all special project work and provides recommendations for revenue managing opportunities related to special projects. Demonstrates ability to effectively manage multiple projects. Develops effective relationships among internal/external stakeholders, colleagues, and staff in order to build trust and lead individuals/teams through change initiatives. Regularly communicates with clinical leaders, revenue cycle staff, IT, finance, managed care, and leadership. Performs management functions within the provisions of Adventist Health policies and standards and federal, state, and local regulations. Provides guidance, oversight, and adherence monitoring of CDM and revenue integrity-related departmental policies and procedures. Acts as subject matter expert in clinical and coding fields through journals, seminars, and other materials as applicable. Maintains current knowledge of ICD-10 and CPT coding regulations. Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

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