Cedars-Sinai Senior Manager, Revenue Cycle Compliance in Beverly Hills, California
Senior Manager, Revenue Cycle Compliance Requisition # M11971
The Senior Manager, Revenue Cycle Compliance develops and directs, in coordination with Cedars-Sinai Health System Corporate Integrity Program, a coding, documentation and data quality compliance program for Cedars-Sinai Medical Network. Responsible to the VP of Revenue Cycle and Managed Care Operations for assuring the key elements of an effective revenue cycle compliance program are in place and operationalized as it relates to the Corporate Integrity Program (e.g., policies, education, risk assessments, profiling, work plan, monitoring, reporting and corrective/remedial actions and daily operations). Establishes system wide coding compliance standards and policies related to documentation and charge capture of professional coding and billing practices. Provides guidance and education designed to promote regulatory charge capture, coding and billing compliance within Cedars-Sinai’s Medical Network, Faculty Departments, Enterprise Information Systems and all departments responsible for professional revenue. Provides oversight and guidance to the Managers of PBS Coding and Physician Education to promote documentation and data quality, compliant billing, charging and Revenue Cycle operational practices, as required by Federal and state legal requirements and payer policies. In consultation with the VP, identifies compliance issues, interprets relevant laws, statutes and policies governing compliance issues, and coordinates and/leads projects or policy redesigns to accomplish compliance with the laws applicable to Cedars-Sinai Medical Network. Assures that operations leverages leading practice industry standards and meets all regulatory and compliance requirements. Oversees planning, preparation and presentations of budgets that demonstrates prudent use of the organization’s resources while at the same time achieving and maintaining organizational goals and key performance indicators. The goals of the Revenue Cycle Compliance program are to further the Cedars-Sinai Medical Network mission of providing quality health care to our patients, while at the same time, advancing the prevention of fraud, waste and abuse in our health care delivery system.
ESSENTIAL JOB DUTIES:
• Analyzes reports on, and provides recommendations on corrective action plans, disciplinary actions or compliance issues and risks
• Sets long and short range goals, and implements strategies to meet desired objectives.
• Monitors clinical and non-clinical documentation is in accordance with Government guidelines to support claims and all applicable regulations including but not limited to: CPT, ICD10 and HCPCs coding and documentation and medical necessity, Physicians at Teaching Hospitals, Billing for Non-Physician Practitioners, Scribes and Locum Tenens. Uses audits and/or other evaluation techniques to monitor compliance and ensure reductions in identified problem areas.
• Identifies risk areas associated with coding and billing, including billing for services not rendered; double billing, upcoding, etc.
• Ensures documentation of, and updates to, Billing Compliance Standards of Conduct and Policies and Procedures to address compliance issues and areas of risk and fraud.
• Stays abreast of all regulatory changes and insures compliance analysts (staff and vendors), PBS and coding vendors managed by PBS are clear on changes.
• Creation, management, and communication on changes to interpretation of coding, documentation and billing rules that may not be specifically stated in Government regulations. This is typically referred to as ‘the gray’.
• Attends, and is directly involved in, any compliance committees and follow-up from committee recommendations
• Oversees the development of coding and documentation training materials
• Oversees development education and training programs for employees and providers
• Provides timely and appropriate responses to inquiries and complaints; develops correction action, including the investigation and resolution of identified problems.
• Reviews templates for compliance to help decrease risk of over-coding based on copy forward, cut & paste and cloning.
• Serves as a technical resource for compliance and coding related issues for providers, EIS, management and PBS
• Develops and implements internal chart audit program to ensure proper documentation and coding as well as identify gaps where education is warranted by providing feedback and focused educational meetings based on the results of auditing and monitoring activities to the providers.
• Ensuring the appropriate communication of all regulation, policy and guideline changes to appropriate team members.
• Oversees and manages daily operations of the Coding and Auditing departments including the planning, organizing, staffing, directing, and other functions within the department
• Handles in a professional and confidential manner all correspondence, documentation, and files
• Supports CSMN core values, policies, and procedures
• Completing other job related assignments and special projects as directed
• Monitors conformity with compliance policies and procedures
• Manages daily activities for staff members, including job interviewing and hiring; preparation of employee performance reviews; determination of raises, promotions, transfers, and terminations in conjunction with the Vice President Revenue Cycle and Managed Care Operations.
• Encourages and teaches staff to support CSMNS core values, policies, and procedures
• Develops and coaches staff to ensure they have the skills necessary for optimum performance
• Counsels employees regarding work, attendance, etc. as appropriate, and within departmental guidelines
• Communicates policies and procedures effectively and regularly to staff and physicians
• Provides both written and verbal analyses and recommendations to senior management.
• Keeps staff and physicians informed by communicating in a clear, effective, and timely manner
• Works closely with other Managers (Training, Education, Coding, Billing and Collections, etc.) in identifying, addressing, and resolving compliance-related risks, such as claims submission process, unbundling, up coding, etc.
Education Certifications/Licensure Experience Physical Abilities Experience
• At least five (5) or more years’ experience working in physician billing compliance in a large, preferably academic institution. Experience with the Compliance Program for Physician Practices from the Office of Inspector General.
• 5 years’ experience in researching complex coding compliance issues and questions, and ability to develop effective education programs for adult learners (coders, physicians, nurses) is required.
• Bachelor degree from an accredited college or university required. Master’s degree preferred.
• Expertise with CPT-4 and ICD-10 coding and medical records documentation
• Expertise of procedures and data flow in a health care organization; experience with physician billing preferred
• Certified Procedural Coding – CPC
• Certified Coding Specialist – CCS preferred
SKILLS AND KNOWLEDGE
• Requires and in-depth knowledge of medical terminology, anatomy, physiology, health information computer systems, and documentation requirements for multi-specialty physician practices.
• Must be well versed in documentation and coding requirements for professional services and for both inpatient and outpatient hospital and ancillary provider settings.
• Requires current knowledge of medical billing procedures and third party payer and Medicare/Medicaid practices and procedures.
• Demonstrates excellent communication skills, both verbal and written, and educational skills to instruct Cedars-Sinai Medical Network management, providers, staff, and patients and a high level of interpersonal skills to obtain necessary cooperation and support.
• Demonstrates strong leadership skills necessary to handle daily operational activities, analyze situations, make appropriate responses, coordinate resources to meet organizational and departmental needs and supervise assigned team members.
• Knowledge of CMS rules and regulations and current coding resources including CPT, ICD-9-CM, ICD-10-CM, HCPCS, fee schedule and HCC’s.
• Must have a working knowledge of management of an effective ethics and compliance program, including training, monitoring, conducting and documenting investigations, addressing violations and monitoring corrective actions
• Should have working knowledge of federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), federal and state anti-kickback and physician self-referral laws (e.g., Stark and PORA), and provider and practitioner licensure and scope of practice requirements, privacy and consent laws.
• Must have demonstrated strong leadership skills, the ability to manage projects across the system is required, including the ability to positively influence other without direct lines of authority to a positive outcome.
• Understanding of computer systems, as well as expertise with office based programs such as Word, PowerPoint and Excel. Experience with Electronic Medical Records is required. Experience with Epic is a plus.
• Excellent written, verbal and presentation skills in the English language
- Working Title: Senior Manager, Revenue Cycle Compliance
- Business Entity: MDN - Medical Delivery Network
- Cost Center # - Cost Center Name: 0861059 - PBS Compliance
- City: Beverly Hills
- Job Category: Finance/Patient Financial Services
- Job Specialty: Patient Accounting
- Position Type: Regular-F/T
- Shift Length: 8hr
- Hours: 8:00am - 5:00pm
- Days: Monday - Friday
- Shift Type: Day
- Weekends: None
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.