Director, Revenue Cycle Integrity and System Audits (Hybrid)
- Employer
- Adventist HealthCare
- Location
- Gaithersburg, MD
- Posted
- Mar 28, 2023
- Closes
- Oct 01, 2023
- Ref
- R-024694
- Function
- Executive, Director, Management
- Industry
- Healthcare
- Career Level
- Experienced (Non-Manager)
- Hours
- Full Time
Adventist HealthCare seeks to hire an experienced Director of Revenue Cycle Integrity and System Audits who will embrace our mission to extend God's care through the ministry of physical, mental and spiritual healing.
As a Director of Revenue Cycle Integrity and System Audits you will:
•Work closely with clinical and ancillary departments to ensure compliance and revenue integrity with government, payer, and charge capture requirements.
•Maintains current knowledge of Medicare, Medi-Cal, and Managed Care billing compliance guidelines and requirements as they pertain to charges, billing and coding operations.
Communicates regulatory changes in a timely manner to client clinical and ancillary departments and to Adventist Healthcare staff.
•Supports the maintenance and configuration of the CDM through Revenue Cycle processes and knowledge with focus on regulatory coding requirements, compliance, revenue integrity, standard naming conventions and pricing integrity.
•Provides education to clinical and ancillary departments regarding revenue cycle, revenue integrity, cost to charge ratios and item/service pricing, and compliant use of CPT codes, HCPCS codes, revenue codes, and modifiers.
•Reviews data reports/spreadsheets as necessary or requested; writes real-time and ad hoc reports as needed or requested; conducts research to resolve identified potential patient billing and account issues; initiates account/charge corrections as needed.
•Performs basic financial analyses pertaining to the potential impact of changes in payment/reimbursement resulting from a change in payer practices: Medicare, Medi-Cal, Managed Care, and CMS regulatory changes.
•Leads projects to improve revenue integrity and charge capture compliance and efficiency in the charge capture process and CDM charge structures.
•Actively keeps up to date with new developments in the industry including State, Federal, OIG and Managed Care billing and coding regulations.
Qualifications include:
•Minimum seven (7) years related work experience.
•Minimum seven (7) years CDM experience with government and non-government.
•Bachelor degree required, or 10 plus years related experience with at least 5 years as a current RCI director
•Possession of CPC or CCS certification is preferred.
•Thorough understanding of Medicare, Medi-Cal and third-party requirements; revenue codes, CPT codes, HCPCS codes, and Medi-Cal codes; NCCI/OPPS edits; ICD-9 and ICD-10coding; APC classification systems; medical terminology; billing and reimbursement practices and processes for all payer groups.
•Knowledge of the relationship of the CDM to areas such as the General Ledger, cost accounting, cost reporting and budget; clinical settings such as Nursing, Laboratory, Radiology, Physical/Occupational/Speech Therapy, Surgery, Labor & Delivery, Endoscopy, Respiratory Therapy, Cardiology, and Oncology.
•Ability to research coding and billing regulatory requirements and the impact of the CDM on reimbursement, revenue integrity, and coding guidelines.
•Knowledge of local, state and federal regulatory billing and coding requirements.
•Knowledge of APC's including NCCI and OPPS error edits.
•Strong verbal, written and interpersonal communication skills.
Work Schedule:
Monday to Friday 8-5. Hybrid options available.
At Adventist HealthCare our job is to care for you.
We do this by offering:
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today, apply now to be considered!
COVID-19 Vaccination
Adventist HealthCare requires all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination and, if needed, may elect to be vaccinated at any community pharmacy or location offering COVID-19 vaccinations.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).
Equal Employment Opportunity
Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law.
Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs.
Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.
As a Director of Revenue Cycle Integrity and System Audits you will:
•Work closely with clinical and ancillary departments to ensure compliance and revenue integrity with government, payer, and charge capture requirements.
•Maintains current knowledge of Medicare, Medi-Cal, and Managed Care billing compliance guidelines and requirements as they pertain to charges, billing and coding operations.
Communicates regulatory changes in a timely manner to client clinical and ancillary departments and to Adventist Healthcare staff.
•Supports the maintenance and configuration of the CDM through Revenue Cycle processes and knowledge with focus on regulatory coding requirements, compliance, revenue integrity, standard naming conventions and pricing integrity.
•Provides education to clinical and ancillary departments regarding revenue cycle, revenue integrity, cost to charge ratios and item/service pricing, and compliant use of CPT codes, HCPCS codes, revenue codes, and modifiers.
•Reviews data reports/spreadsheets as necessary or requested; writes real-time and ad hoc reports as needed or requested; conducts research to resolve identified potential patient billing and account issues; initiates account/charge corrections as needed.
•Performs basic financial analyses pertaining to the potential impact of changes in payment/reimbursement resulting from a change in payer practices: Medicare, Medi-Cal, Managed Care, and CMS regulatory changes.
•Leads projects to improve revenue integrity and charge capture compliance and efficiency in the charge capture process and CDM charge structures.
•Actively keeps up to date with new developments in the industry including State, Federal, OIG and Managed Care billing and coding regulations.
Qualifications include:
•Minimum seven (7) years related work experience.
•Minimum seven (7) years CDM experience with government and non-government.
•Bachelor degree required, or 10 plus years related experience with at least 5 years as a current RCI director
•Possession of CPC or CCS certification is preferred.
•Thorough understanding of Medicare, Medi-Cal and third-party requirements; revenue codes, CPT codes, HCPCS codes, and Medi-Cal codes; NCCI/OPPS edits; ICD-9 and ICD-10coding; APC classification systems; medical terminology; billing and reimbursement practices and processes for all payer groups.
•Knowledge of the relationship of the CDM to areas such as the General Ledger, cost accounting, cost reporting and budget; clinical settings such as Nursing, Laboratory, Radiology, Physical/Occupational/Speech Therapy, Surgery, Labor & Delivery, Endoscopy, Respiratory Therapy, Cardiology, and Oncology.
•Ability to research coding and billing regulatory requirements and the impact of the CDM on reimbursement, revenue integrity, and coding guidelines.
•Knowledge of local, state and federal regulatory billing and coding requirements.
•Knowledge of APC's including NCCI and OPPS error edits.
•Strong verbal, written and interpersonal communication skills.
Work Schedule:
Monday to Friday 8-5. Hybrid options available.
At Adventist HealthCare our job is to care for you.
We do this by offering:
- Work life balance through nonrotating shifts
- Recognition and rewards for professional expertise
- 403(b) retirement plan
- Free Employee parking
- Benefits Eligible Positions:
- Competitive, comprehensive benefit plans [including health, employer-paid disability and life insurance, PTO]
- Employer retirement contribution and match after 1-year of eligible employment with 3 year vesting
- Ancillary benefits such as flexible spending, legal and pet insurance to meet the needs of employees and their eligible family members
- Subsidized childcare at participating childcare centers
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today, apply now to be considered!
COVID-19 Vaccination
Adventist HealthCare requires all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination and, if needed, may elect to be vaccinated at any community pharmacy or location offering COVID-19 vaccinations.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).
Equal Employment Opportunity
Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law.
Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs.
Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.
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