Key
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 assure 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 relationship 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 in order 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 objective for each employee to measure performance and cross training
to mutually agreed-upon expectations and provides employees 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
MINIMUM QUALIFICATIONS
· Bachelor's
Degree in business, healthcare administration or related area and a minimum of
eight (8 ) 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 requirement 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 QUALIFICATIONS
· Advanced degree
in business, finance or relevant field of study.
· Ten (10 ) 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
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