Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation???s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. Join us! Discover why U.S. News & World Report has named us one of America???s Best Hospitals.??
What you be doing in this role:
The Manager, Compliance and Revenue Integrity (CRI) manages one or more functions within the Compliance and Revenue Integrity organization. They are responsible for the strategic and operational oversight of their assigned function(s) including overseeing staff, developing policies, procedures, and workflows to ensure maximum efficiency and accuracy. They are also responsible for data integrity and provide strategic analysis of data/reports, conveying findings and making recommendations to senior leadership.??
Areas of assigned responsibility may include managing the processes for charge capture, charge reconciliation, charge maintenance, pricing strategy, CDM/fee schedules (hospital and professional fee/clinic pricing), charge tickets creation and maintenance, charge edits, clinical denials, revenue-related audits, revenue cycle regulatory monitoring and compliance, and multidisciplinary clinical, operational, and financial revenue practice teams.??
Responsible for evaluating finalized claims, adjustments, complex customer concerns, and audits to identify and track issues related to billing, coding, system functionality, clinical documentation, and regulatory needs.
Develops and reports out on findings for different quality reviews and helps not only to identify common issues but make recommendations on appropriate steps for remediation.
Monitors process improvements related to compliance and revenue opportunities and takes a leadership role in informing partners and providing solutions.
Serves as a subject matter expert and will be called upon to provide opinion and guidance on issues related to coding, billing, and operational compliance.
Manages, coordinates, and champions multiple revenue cycle initiatives across the organization (PB/HB) to improve processes and support optimal high-performing revenue cycle operations.
Oversight of the team managing the Medicare and Medicaid RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates to Compliance, Utilization Review, and Finance leadership. Partners with internal counsel and external vendors during all levels of the appeal process including settlement conferences and trials. Maintains and monitors high success rates in the audit program.
Provides reporting and feedback to Revenue Cycle and clinical operations collaborators to support correct and compliant documentation, coding, charge capture and billing across the system for all hospital and professional services patient accounts and locations.
This role partners with departments to reduce revenue leakage through impact studies, revenue reviews, and industry best practice.??
May manage assigned teams for the optimization of net revenues.??
Responsible and accountable for implementing revenue capture strategies and ensuring efficient and compliant revenue processes which ensure that the organization collects all revenue to which it is entitled while maintaining compliance.
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Qualifications
Requirements:
Bachelor's degree in business, economics health or a related major required.??
Coding or health care compliance certifications and Epic certifications preferred.??
A minimum of 5 years of experience in revenue cycle, revenue integrity or billing experience in a hospital based or medical office setting required.
5 years or more of proven experience in revenue cycle, revenue integrity or billing experience in multi-specialty medical group or medical office setting preferred.
Management and supervisory experience preferred.
Why work here?
Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.
Req ID : 5218 Working Title : Manager, Compliance & Revenue Integrity Department : CSRC Dir Compliance and Rev Mgt Business Entity : Cedars-Sinai Medical Center Job Category : Patient Financial Services Job Specialty : Revenue Integrity Overtime Status : EXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : $46.35 - $81.11
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NAHQ wants to partner with you and your organization as you explore how to elevate the profession and advance the discipline of healthcare Quality & Safety.
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For customer service issues, contact us at info@nahq.org or call us at (847) 375-4720. The team is available Monday-Friday from 8 AM-4:30 PM CT.
Important Information for CPHQ Recertification
The recertification process has been streamlined. Unlike previous years, you don’t need to list out your CE activities at the time of completing your application. Instead, you will be asked to attest to having met the requirements, further aligning with the honor-based system of recertification. In the event that your application is randomly selected for audit, you may be required to list your CE activities and submit supporting documentation.
While you may participate in NAHQ learning opportunities (Learning Labs, JHQ articles, etc.), you can only claim CE credit once for each activity. Therefore, if you’ve previously earned CE from a NAHQ learning opportunity, you can’t claim it again, nor will you see the repeat CE appear in your “My Learning� tab. This includes activities used in previous recertification cycles.
Remember, if you’re recertifying during the grace period (1/1/24-1/31/24), you already had to earn your CE hours by Dec 31, 2023.
You still have time! Register today for a multi-day virtual event that addresses the most urgent and important issues facing healthcare today that offers a full schedule of educational sessions organized around NAHQ’s twice-validated healthcare quality competency framework.
We are excited to announce the release of the book “UNSTOPPABLE: Inspiring Stories of Perseverance, Triumph and Joy from Trailblazing Women in Healthcare“.
Be inspired by nine leading healthcare trailblazers, including our own CEO Stephanie Mercado, who empower us all with their vision and passions.
You’ll notice we’ve simplified the application process to recertify. You will not have to list your CE activities at the time of applying*. Simply attest that you met the requirements to complete the application.
*In the event of an audit, CPHQs may need to list activities and upload documentation in their NAHQ account.
Quality Education Resources
Join this informative session, “Quality Education Resources� Thursday, June 22 from 11-11:30 a.m. CT. You will learn about the range of NAHQ quality education resources available to you and hear directly from universities about the benefits they realized from implementing NAHQ’s content within their courses.
Maintain a Pulse on the Latest Quality & Safety Benchmarking Data
Learn more about NAHQ’s enhanced Quality and Safety Benchmarking Program, which provides timely insights to help U.S. hospitals and health systems create data-driven business cases for their quality and safety resourcing.
Understand the Variability Among Your Quality Team Through Workforce Accelerator
Join us Tuesday, May 2, at 11 a.m. CT, to learn more about the different options available to engage with NAHQ’s enterprise-wide solution, Workforce Accelerator®. Options range in size and scope and are designed to meet the various budgetary and timing needs of health systems as they embark on their quality journeys. Register today!
Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development
The National Association for Healthcare Quality® (NAHQ) has conducted groundbreaking research on the advancement of the quality and safety agenda and has published the results in a new workforce report. NAHQ’s Healthcare Quality and Safety Report answers the question: “Is today’s healthcare workforce doing the work that will advance critical priorities of quality, safety, equity, value, and system sustainability?� The answer is no.
Updated Maintenance Dates: Sunday, February 5, 2023
Maintenance is planned for Sunday, February 5, from 11 p.m.-4 p.m. CT. During this time, you will not have access to the “My Learning” section of your NAHQ account. We apologize for any inconvenience this may cause and thank you for your patience.
NAHQ’s Organizational Membership Subscription will serve as a one-stop shop for healthcare quality and safety training and education. Attend the February 2, at 11 a.m. CT, info session to further understand the new offering that will continue NAHQ’s focus of “Quality in Action.�
NAHQ has published an updated version of the CPHQ exam content outline.
The new exam content will take effect on March 15, 2023. Candidates planning to take the exam before March 15, 2023, can access the current CPHQ exam content outline and related resources on our website.
Missed NAHQ Next? Don’t worry, you can purchase NAHQ Next on-demand and receive access to all content for 60 days from purchase. Benefit from actionable content that addresses issues head-on and features “how-tos” and results. Buy now and have the opportunity to receive 40+ CEs.
Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development
Member Briefing Workshop and Healthcare Quality Week Webinar
October 7, at 12 p.m. CT
NAHQ will host an exclusive member briefing workshop where NAHQ CEO Stephanie Mercado and NAHQ President-Elect Nidia Williams will review the workforce report in-depth and prepare you to discuss it with your team and leadership during Healthcare Quality Week.
October 17, at 12 p.m. CT
To kick off Healthcare Quality Week, (HQW) NAHQ will host a complimentary webinar with NAHQ leaders to discuss the report, its impact and how you can leverage the report to your advantage.
You still have time! Register today for a multi-day virtual event that addresses the most urgent and important issues facing healthcare today that offers a full schedule of educational sessions organized around NAHQ's twice-validated healthcare quality competency framework.