Director, Revenue Integrity - 134409

UC San Diego Health's Revenue Cycle supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients.

The Director Revenue Integrity promotes the financial viability of the UCSD Health System by effectively managing all aspects of the organization's revenue capture operations. The Director works in close partnership with many aspects of the organization and is central to creating a comprehensive and seamless revenue cycle. The Director Revenue Integrity works collaboratively with revenue generating departments and providers in the development, execution, and follow up education to physicians and clinicians related to charging and billing compliance. Acts as a central point for disseminating information and guidance related to the charging of services, supplies and pharmaceuticals. Identifies ways to improve work processes, enhance quality, productivity, and service delivery.

Responsible for personnel management, resource management, quality assurance of the UCSD Revenue Integrity staff including Charge Capture and Charge Description Master Workload to ensure Charge Description Master Activities are executed accurately and efficiently. Ensures adherence to established policies, government regulations and payor requirements. This position reports directly to the Chief Revenue Cycle Officer.

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

• Bachelor's Degree in business, healthcare administration or related area and a minimum of eight 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.

• Advanced degree in business, finance or relevant field of study.
• Ten 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

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.