Cedars-Sinai Senior Manager, Revenue Cycle Compliance in United States
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As a Senior Manager of Revenue Cycle Compliance you will have the opportunity to collaborate with the Cedars-Sinai Health System Corporate Integrity Program to support the needs of Cedars-Sinai Medical Network where coding, documentation and data quality compliance is needed. An important part of this role requires establishing system wide coding compliance standards and policies related to documentation and charge capture of professional coding and billing practices. You will provide guidance and education to all departments, including Cedars-Sinai Medical Network, Faculty Departments, Enterprise Information Systems, to promote regulatory charge capture, coding and billing compliance. You will also provide guidance to the Managers of PBS Coding and Physician Education to promote documentation and data quality, compliant billing, charging and Revenue Cycle operational practices. This position requires an influential leader who is a dedicated professional with a commitment to excellence.
Essential Job Duties include:
Develops and directs a coding, documentation and data quality Professional compliance program for Cedars-Sinai Medical Network.
Assuring the key elements of an effective revenue cycle compliance program are in place and operationalized such as policies, education, risk assessments, profiling, work plan, monitoring, reporting and corrective/remedial action plans.
Establishes system wide coding compliance standards and policies related to documentation and charge capture of professional coding and billing practices.
Analyzes, reports on, and provides recommendations on corrective action plans, disciplinary actions or compliance issues and risk.
Monitors clinical and non-clinical documentation 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 Locums Tenens. Uses audits and/or other evaluation techniques to monitor compliance and ensure reductions in identified problem areas.
Oversees the development of coding and documentation training materials and programs for employees and providers.
Managers 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 of Revenue Cycle and Managed Care Operations.
You must have a minimum of 5 years of experience in working in physician billing compliance in a large, preferably academic institution, minimum of 5 years of experience in researching complex coding compliance issues and questions, and ability to develop effective education programs for adult learners is required and must be CPC certified, CCS certification is preferred. You must understand computer systems, preferably EPIC, and computer programs such as Word and Excel and have working knowledge of management of an effective ethics and compliance program, including training, monitoring, conducting and documenting investigations, addressing violations and monitoring corrective actions. You must also have in-depth knowledge of medical terminology, anatomy, physiology, health information computer systems, and documentation requirements for multi-specialty physician practices. Preferred candidates will have a Master’s degree, and experience in governmental chart reviews. You would be expected to conduct all work on-site and travel between facilities.