Director, Revenue Integrity

  • Oakland, CA
  • Finance
  • Revenue Integrity
  • Full Time - Day
  • Management
  • Req #: 29193-19682
  • FTE: 1
  • Posted: July 16, 2021
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Summary

Role Overview

Alameda Health System offers outstanding benefits that include:

  • 100% employer health plan for employees and their eligible dependents
  • Unique benefit offerings that are partially or 100% employer paid
  • Rich and varied retirement plans and the ability to participate in multiple plans.
  • Generous paid time off plans

The Director of Revenue Integrity is responsible for assuring the timeliness, accuracy, completeness and thereby compliance related to charge capture.  The Director of Revenue Integrity supports clinical departments in the clinical capture and triggering of charges for patient services provided (aka charging workflows) and the resolution of any charging pending due to provider delays or errors (e.g., charges landing in Charge Router or Charge Review WQs).  In addition, the Director of Revenue Integrity assures all services provided at our Hospitals and Clinics are built within the Epic CDM (Hospital and/or Professional) and have a valid Price and modifier associated.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level.  Not all duties listed are necessarily performed by each individual in the classification.
 

  • Hires and trains new employees, assigns work, disciplines and counsels work related performance issues and responsible for managing staff against workload goals and standards of performance.
  • Directs, oversees, and maintains the Charge Description Master content for both Hospital & Professional services. This in includes assuring charges (EAPs) exist and are active (or inactive) with the HCPCS/CPT, Revenue Code, and Pricing.
  • Partners with Billing teams to assure Epic CDM output aligns with payor billing requirements as well as Organizational Pricing Strategies.
  • Advises the Epic IT Team and Clinical departments on the appropriate charges to associate with clinical activities and corresponding documentation, assuring this is addressed in the Epic Charging Workflows
  • Partners with stakeholders across AHS, including Clinical, IT, Compliance and Revenue Cycle to facilitate issue resolution/prevention, optimization, and implementation of new services and technology to assure the integrity of AHS revenue.
  • Develops and Maintains organizational policies and procedures related to charge capture, charge review, charge reconciliation, CDM maintenance (including Pricing methodology), along with Revenue Integrity department-specific Policies & Procedures to assure proper guidance for compliant charge capture.
  • Monitors department compliance with applicable policies related to timely, accurate, and complete charge capture and facilitates/supports resolution of any issues impacting the integrity of AHS revenue.
  • Conducts routine and ad hoc analysis based on in inquiries related to Charge Capture, Charge Reconciliation, CFB and Denials (Errors/Codes assigned to Revenue Integrity). 
  • Conduct periodic audits of Charge Capture & Reconciliation activities and outcomes and contribute to internal and external agency audits related to charging.
  • Directly and indirectly contributes to the overall financial health of AHS by monitoring and continuing to reduce - through resolution and prevention – Revenue Integrity-owned CFB (Candidate for Bill) errors as reflected in various Epic Dashboards and Reports.

MINIMUM QUALIFICATIONS:  

 

Education:  see Minimum Experience section below

Minimum Experience:
Must meet at least one of the specified minimum Education & Experience combinations:
A bachelor's degree from an accredited college with 7+ years of related experience OR 10+ years of related experience with applicable industry certifications (e.g., Coding Certification, Epic Certification)
OR
A high school degree with 10+ years of related experience with applicable and active industry certifications (e.g., Coding Certification, Epic Certification)
AND Must meet all of the following:
3+ years in management of teams and/or projects
5+ years of Revenue Cycle Experience
1+ years of experience with Epic

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