$200K — $250K *
This paragraph summarizes the general nature, level and purpose of the job.
The Director Revenue Integrity promotes the financial viability of the Stanford Hospitals and Clinics 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 throughout Stanford Hospitals and Clinics and the School of Medicine (SOM). In addition, the director plays a key role in coding compliance and strategies for payor contracting.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities required by positions in this job classification. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility entailed.
· Maintains the hospital's charge description master (CDM) by incorporating new charges/services identified by the Revenue Integrity Program Managers, as well as the revenue generating departments, third party changes, CMS special requirement and coding updates. Directs the monitoring and approves all changes made to the hospital's charge description master and professional fee schedule, consistent with third party requirements.
· Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional billing office.
· Works collaboratively with the revenue producing department staff, physicians and school of medicine (SOM) to ensure all charges are being captured and documented.
· Fosters partnering relationships with the Compliance Office, Patient Financial Services, Professional Billing Office, Health Information Management department, and other third parties to ensure the accuracy of the CDM and fee schedules.
· Oversees efforts to ensure timely response and compliance with regulatory agencies.
· Educates hospital departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.
· Ensures timely review of regulatory literature such as Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting Stanford Hospital and Clinic's CDM and charge capture systems.
· Coordinates with Patient Financial Services, Professional Billing Office, Health Information Management department and other coding professionals to ensure that the codes contained in the CDM and professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
· Ensures the on-going accuracy and integrity of the CDM and professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments and physicians to implement necessary changes to charge documents, charge capture process, and order entry procedures.
· Identifies services that are reimbursable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes and sets rate. Determines charge and charge attributes for new services and products and responsible for developing and maintaining a rate setting policy.
· Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional fee schedule. Works collaboratively with the revenue producing department staff and physicians to ensure all charges are being captured and documented.
· Facilitates positive communication and build strong relationships between Professional Revenue Cycle Management Operations and clinical chairs (School of Medicine), administrators, other clinic and departmental staff and payors regarding revenue cycle matters.
· Establishes revenue cycle reporting requirements to meet the needs and expectations of all constituencies (Director, Finance & Administration -DFAs; Faculty, Director of School Medicine Finance Support) and ensures timely reporting of revenue cycle performance through collaboration with appropriate information sources.
· Participates in Manage Care Contracting Committee as a member, with active involvement in pricing and contracting strategy decisions. Ensures that payor contract performance is monitored.
· Participate in various IT-related steering committees for information technology changes which affect the revenue cycle and leads planning initiatives for revenue cycle IT related enhancements.
· Establishes performance goals and expectations relevant to the professional revenue cycle. Prepares annual objectives, plan of action and budgets, as appropriate. Monitors benchmark data related to revenue cycle performance.
· Develops and produces executive and board level CDM and Revenue Capture dashboard reporting, recommendations and oversight of organization-wide CDM and Revenue Cycle strategies and process improvements.
· Plans and schedules annual audit of selected hospital departments; compares medical records against claim to ensure optimum and appropriate charge capture and coding accuracy.
· Manages and monitors the performance of external vendors that provide CDM related products and services; selects and coordinates any third-party vendor conducting annual charge master reviews or periodic updates.
· Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
· Leads the planning, development and implementation relative to the CDM policies and Procedures manual.
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities is qualifying.
Education: Bachelor's degree in a work-related field/discipline from an accredited college or university.
Experience: Seven (7) years of progressively responsible and directly related work experience.
Member in Healthcare Financial Management Association or the American Academy of Professional Coders or American Health Information Management Association preferred.
Knowledge, Skills, and Abilities
· Knowledge of all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing and collection processes, as well as government and payer regulations.
· 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, and service item master.
· Knowledge of principles and practices of organization, administration, fiscal and personnel management.
· Knowledge of local, state and federal regulatory requirement related to the functional area.
· 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.
· Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
· Ability to provide leadership and influence others.
· Ability to foster effective working relationships and build consensus.
· Ability to mediate and resolve complex problems and issues.
· Ability to develop long-range business plans and strategy.
Valid through: 12/1/2020