Senior Manager, Revenue Integrity

Updated: 2 months ago
Location: United States,

About City of Hope

City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.

Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research.  City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers that develops and institutes standards of care for cancer treatment.

Position Summary:

Responsible for providing overall leadership and direction for the Revenue Integrity team at City of Hope. Major areas of responsibility include management and oversight of all charge capture and revenue integrity activities, including Research billing processing. This position will have a specific focus on the revenue integrity team, driving and enhancing the effectiveness of patient net revenue realization and identifying potential leakage. The Senior Manager will monitor and trend and appeal late charges, clinical denials and issue resolution.   Additionally, this position has operational oversight of the Charge Description Master (CDM) activities and processes, proactively implementing timely changes to CDM to ensure items accurately reflects all line items eligible for billing and that it complies with Federal/State guidelines. Supports and facilitates the annual CDM pricing review; ensures alignment with City of Hope Pricing Committee objectives.

The Sr. Manager, Revenue Integrity works collaboratively with revenue generating departments and providers in the development, execution, and follow up education to physicians and clinicians related to 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.  Conducts periodic audits of the CDM and reviews to ensure accuracy, consistency, integrity and adherence to compliance regulations.  Is an active participant in the annual pricing endeavor, ensuring market position is aligned with organization’s goals.  Leverages technology and responsible for the continual evaluation and improvement process to improve A/R and better patient experiences.

Responsible for personnel management, resource management, quality assurance of the Medical Center 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. Reports to Executive Director, HIM.

Key Responsibilities include:

  • 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 including:
    • 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
    • Works directly with Clinical teams to assist in resolution of clinical denials
    • 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
  • 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
  • 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 Master
  • 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 
  • Manage Craneware Tools
  • Engage, develop, and manage the performance of revenue owning departments
  • Attract, retain and develop quality management and other team members, while providing leadership and serving as a role model
  • Directly and indirectly oversee the hiring, training, engagement and termination of employees.
  • Communicate effectively with staff to keep them informed of changes within and outside applicable departments
  • Facilitates a cross-training work force to build a cohesive work environment. 
  • Design programs to attract and retain the best staff, develop a culture of pride and ownership and provide opportunities for learning and growth.
  • Monthly meeting with involved departments to address billing/charge-capture compliance concerns
  • Leads bi-monthly Charge Master Committee meetings to ensure timely and accurate completion of agenda items and maintains meeting minutes
  • Leads quarterly Revenue Cycle Integrity and Operation Committee meetings
  • Manages annual CDM Pricing change and Pricing Transparency
  • Evaluates and implements new technology, and acts as a catalyst for change to meet current and future business needs
  • Provide subject matter and technical expertise in the design and implementation of HER in Revenue Cycle and related applications
  • Analyzes weekly charge reconciliation reports 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.
  • Service quality and work quality to meet required COH, 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.

Basic education, experience and skills required for consideration:   

  • Bachelor’s Degree.
  • 5+ years of Revenue Integrity or HIM experience serving in a leadership role managing more than 5 full time employees. (academic, hospital, medical group and/or hospital, ambulatory setting).
  • 3 years of management experience.
  • Significant clinical and/or clinical coding knowledge; background in billing compliance.
  • Must have technical knowledge of correct coding principles of CPT/HCPCS and modifier selection as well as UB-04 revenue codes.
  • Must have technical knowledge of correct coding principles of CPT/HCPCS and modifier selection, as well as, UB-04 revenue codes.
  • Experience with medical record to bill reviews for charge capturing accuracy.

Req. Certification/Licensure: 

  • Active certification as a Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P) from the American Health Information Management Association (AHIMA).

Preferred Courses/Training:

  • Epic Revenue Integrity, Hospital and/or Professional Billing (Resolute).
  • Training Courses in CDM, Strategic Pricing, Billing and Regulatory Compliance, Revenue Cycle.

Preferred Citification/Licensure:

  • Epic

City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

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