Description
The Clinical Revenue Integrity Manager will manage the charge capture team and support unit and the area specific charge capture of clinical services and procedures. Clinical Revenue Integrity Manager is also responsible for communicating missing or incomplete clinical documentation and charge entry errors for clinical department process improvement.
The Clinical Revenue Integrity Manager delivers direction to the documentation of all policies and procedures regarding charge capture and CDM Maintenance; and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance. The Clinical Revenue Integrity Manager also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the he improvement of charge capture.
As a subject matter expert in the area of compliance the Clinical Revenue Integrity Manager responds to inquiries regarding Chargemaster and charge entry issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement. The Clinical Revenue Integrity Manager works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner; and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.
Essential Duties:
- Perform maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date.
Assists the Revenue Cycle in annual coding review and processing of updates. - Oversees the reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
Oversees the reviews of medical documentation for administration times and location of delivery such as chemotherapy, infusion, hydration injections, observation care, etc. from multiple sources and enter hospital charges accurately, timely and in accordance with Keck Medical Center of USC charge capture policies/guidelines, into Patient Accounting System. - Manage the charge capture team to ensure that coordinators are accountable to organizational and departmental policies including ensuring high integrity in executing charge methodologies.
Trains new employees on the charge entry process.
Performance management responsibilities include, but are not limited to: involvement in decisions and actions of hiring and termination, coaching and development, rewards and recognition, functional performance management and staff productivity.
Plans, organizes, staffs, and directs the day-to-day operations of the department; develops and implements policies and procedures, as necessary. - Lead and Conduct meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards.
Acts a subject matter expert for projects that impact revenue integrity, charge capture and CDM.
Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact. Subject matter expert to meet and/or communicate with various stakeholders for projects that impacts revenue integrity and the CDM. Provide guidance to ensure that CDM's and Charge Capture of newly acquired entities follow the standards and policies of Keck Medical Center of USC. - Provide leadership and guidance to the Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
- Synchronize CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities on a monthly basis.
- Provide CDM data as necessary based on identified issues in form of ad-hoc reports.
Import/extract data from various sources and in various formats as needed to review, monitor, track, and maintain the integrity of the CDM and associate charge flow process. - Performs other duties as assigned.
Required Qualifications:
- Req Degree in healthcare related field
- Req 5 years Experience in medical coding/ Chargemaster experience in a healthcare environment required.
◦ Related experience may include a combination of clinical service delivery (nursing or allied health), coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting. - Req 1 to 2 years' of progressive lead/ supervisorial experience.
- Req Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
Preferred Qualifications:
- Pref Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets) preferred
- Pref Experience and knowledge of Hospital charging practices preferred
- Pref Working knowledge of CPT, HCPCs and ICD9 coding principles preferred
- Pref Healthcare operations experience, particularly in an acute care hospital setting preferred
- Pref Supervisory experience preferred
Required Licenses/Certifications:
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
- Req Registered Nurse - RN (CA Board of Registered Nursing) Or Coding Credentialing from AHIMA or AAPC (CPC, CIC, COC or Certified Auditor (CPMA))
The annual base salary range for this position is $110,240.00 - $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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