Associate Director, Revenue Integrity Quality Assurance

Primary City/State:

Mesa, Arizona

Department Name:

Revenue Integrity Reg Research

Work Shift:

Day

Job Category:

Revenue Cycle

Primary Location Salary Range:

In accordance with Colorado’s EPEWA Equal Pay Transparency Rules.

In 2021, Banner Health was awarded the designation of “Top Revenue Cycle Performance for Large Systems” during the Revenue Cycle Excellence Awards held by Crowe, a national public accounting, consulting and finance service company. The Banner Health Revenue Cycle team was selected for this distinguished designation out of 1,400 large hospitals across the country. Join a team recognized for the innovative and effective strategies that have enabled us to achieve excellence in revenue cycle performance.

This department will support Revenue Integrity Modernization initiatives by providing ongoing review of automated charging functions within the EMR. Team will assist with the development of documentation templates and charge order sets to ensure appropriate charges are captured. Department will work closely with Regulatory to implement changes required by law and payer guidelines. Team will provide scheduled and ad-hoc reviews to maintain revenue integrity and will provide education to clinical staff and other departments as needed.

Excellent opportunity for a highly motivated, skilled leader to assist rapidly growing Banner Health's Modernization improvement efforts. Lead a new team of Quality Assurance Consultants in creating compliant documentation and charging processes. Strong Leadership support team, CEUS for continuing education.

Strong knowledge and background in coding demonstrating progressive experience within a major healthcare organization.

This can be a remote position if you live in the following states(s) only: AR, AZ, CA, CO, FL, HI, IA, ID, MI, MN, MO, ND, NE, NV, PA, SC, TX, UT, WA, WI, WY, NY

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position is responsible for the oversight of the retrospective quality charge reviews for all facilities to ensure all appropriate billable charges are captured as documented within the patient record. This position provides leadership, direction, and support in response to denials from federal, state, and commercial reimbursement programs. This position is responsible for strategies which will minimize charge denials, ensure proper reimbursement for services provided by the organization, which includes auditing, managing, monitoring and reporting on trends and suggesting education to address specific processes, charging and billing regulations to prevent further claims denials.

CORE FUNCTIONS

1. Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for staff assigned to quality charge reviews. Develops goals and performance expectations for staff in targeted areas, quality and timeliness of clinical charge review assignments, data integrity and reimbursement with third party payors. Provides for the education, development, and shared leadership of staff.

2. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.

3. Drives organization performance improvements by refinement and monitoring of facility charge accuracy scorecard which includes over/under charges, % of charge accuracy, reduction of charge denials, % clean claims; staff stats; etc. Participates in the improvement of processes and programs.

4. Works collaboratively with revenue cycle leadership to establish charge quality, productivity, and best practices. Monitors goals and benchmarks productivity and quality standards in conjunction with industry trends. Identifies potential improvements and moves team to achieve next level of performance with regards to compliant charge education, productivity, and best practices.

5. Participates in developing standard charge policies/procedures/guidelines to ensure compliance with federal, state, and local regulatory guidelines to minimize risk for the organization. Supports charge infrastructure to ensure regulatory compliance in all aspects of charging to support patient care processes.

6. Keeps abreast of new medical technologies, procedures and pending regulatory changes which impact the organization. Proactively analyzes potential impact to the organization to minimize adverse impact.

7. Serves as a liaison between finance, clinical departments, and revenue integrity.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

MINIMUM QUALIFICATIONS

Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelor’s degree in business, health care administration or related field, or five to seven years related work experience.

CHCAF, RHIA, RHIT, CCS, or within one year from date of hire.

Must possess a strong knowledge and background in facility charging, coding and billing as normally demonstrated through three or more years of progressive revenue integrity, CDM, chart audit leadership experience preferably within a major health care organization or health system setting. Must have highly developed interpersonal skills and the ability to work collaboratively. Requires the ability to work effectively with all common office software and EMR software applications.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.