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Position Details

Department: Revenue Integrity
Category: Any
Location: Phoenix
Posting #: 425703
Date Posted: 11/30/2018
Employee Type: Regular

Position Summary

The Revenue Integrity Director develops, maintains, and reports on the charge description master (CDM); ensures data and charge integrity between the CDM and hospital departments; researches coding and revenue reporting requirements and uses strategic pricing applications to maximize reimbursement and ensure regulatory compliance. The position will assure accurate charge design, build, validation, testing and quality assurance for all changes to the CDM, electronic and paper charge forms, and charge systems applications. This position reports to the Vice President of Revenue Cycle and supervises the CDM Coordinator.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. Responsible for developing, maintaining and enhancing the CDM in a manner that supports PCH's Coding and Compliance Monitoring Plan.
    • Maintains the CDM by incorporating new charges/services identified by the departments, third-party changes, CMS regulations, federal and state specific coding updates.
    • Performs a detailed, annual review of the CDM that includes identifying CPT and HCPCS codes that have been deleted, added, or replaced; assigns CPT and HCPCS specific codes when appropriate, identifies description changes, ensures the nomenclature reflects the procedures performed, and maintains an audit trail of all changes.
    • Researches and resolves CPT and HCPCS codes, revenue codes, and other issues.
    • Collaborates with the Office of Business Integrity by verifying adherence to charge posting policies and procedures, ensuring compliance with required governmental laws, regulations, contractual requirements, standards and practices both related to the systems charge master.
    • Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, fraud alerts, OIG advisory opinions and other relevant publications. Communicates changes to impacted leaders and provides education on such changes.
    • Establishes and performs periodic billing/claim audits based on CDM complexity and risk.
    • Responds to outside compliance questions, complaints, and inquiries related to CDM items.
  2. Partners with departments and executive leadership to recommend and communicate additions, changes, opportunities, and audit results.
    • Coordinates meetings with department managers, staff and/or physicians regarding new program and procedure developments, equipment acquisitions and validation of inactive codes. Serves as a resource to hospital departments for implementation or regulatory questions.
    • Leads Revenue Integrity Committee. Communicates CDM changes to the hospital departments and administration, revenue cycle, and others who are impacted by the change.
    • Monitors revenue and usage reports daily for anomalies and researches issues. Reviews late charge reports for optimization and efficiency opportunities. Completes and provides other management reports as requested. Routinely reviews revenue recognitions processes across the organization through facilitation of Revenue Review Team.
    • Works with Managed Care to recommend terms and conditions and charge increases with consideration of improving reimbursement.
    • Distributes correspondence of third-party requirements for coding changes to departments for review of the impeding changes.
    • Provides assistance, coordination and education on Revenue Integrity related issues.
  3. Provides technical assistance and oversight for charging of new services and strategic pricing initiatives. Identifies services that are reimbursable, but not being coded.
    • Facilitates annual strategic pricing initiative.
    • Determines charge and charge attributes for new services and products.
    • Identifies services that are reimbursable but are not being coded; reviews, assigns and validates revenue codes. Coordinates adjustments to the current market pricing position to meet organizational goals.
  4. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelors degree in Business Administration or equivalent Required
Do you meet this requirement?
Experience
1. Seven years of experience in revenue cycle operations. Required
2. Five years of experience maintaining CDM. Required
3. Knowledge regarding CPT and HCPCS coding and UB revenue code assignments. Required
4. Knowledge of billing and reimbursement processes and methodologies. Required
5. A strong working knowledge of government payer programs and reimbursement methodologies (CMS, AHCCCS, etc.) and of managed care programs. Required
Do you meet this requirement?
Certifications/Licenses/Registries
1. RHIT/RHIA and CCS Preferred
Do you meet this requirement?
Special Skills
1. Excellent written and verbal communication skills with the ability to effectively interact with all levels of internal and external customers Required
2. Ability to take initiative, effectively use problem-solving skills and adjusts to changes in policy/procedure Required
3. Knowledge of Craneware and AllScripts Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Frequently
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Constantly
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Constantly
13. Physical Requirement - Near Vision Constantly
14. Physical Requirement - Far Vision Constantly
15. Physical Requirement - Color Discrimination Occasionally
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply