What You Will Do:
Under general supervision manages the operations of the Revenue Integrity Department of the University of Maryland Medical System. Manages, trains, recruits, coaches and develops revenue integrity staff within his/her specialized function. Implements, reviews, and modifies all work related to reimbursement methodologies in compliance with HSCRC, federal, state, and local laws/regulations.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
• Manages and directs a team of Revenue Integrity professionals in accordance with departmental and UMMS personnel policies and procedures.
o 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.
o Coaches, mentors and develops staff, including overseeing new employee onboarding and providing career development planning and opportunities.
o Consciously creates a workplace culture that is consistent with the overall organization and that emphasizes the identified mission, vision, guiding principles and leadership values of the organization.
o Holds self and staff accountable for completion of all tasks and projects. Provides oversight of work plan functions, due dates, and preparation of deliverables.
o Empowers employees to take responsibility for their jobs and goals. Delegates responsibilities and expects accountability and regular feedback.
o Fosters teamwork and innovative thinking. Creates a spirit of teamwork and unity among department members that allows for sharing of ideas, debate and decision resolution. Builds an appreciation of diversity as well as cohesiveness, supportiveness, and working effectively together to enable each employee and the department to succeed.
o Maintains transparent communication. Appropriately communicates organization information through department meetings, regular interpersonal communications such as one-on-one meetings, email, video conferencing and IM.
• Supports strategic goals by gathering pertinent business, financial, service and operations information; identifies and evaluates trends and options; chooses a course of action; defines objectives; evaluates outcomes.
• Oversees the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files in various hospital and clinical systems, including oversight of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations.
• Knowledge and understanding of all charge processes within the organization; provides oversight to staff who assist other department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding. Ensures clinical department staff comply with established charge capture and charge reconciliation policies and procedures.
• Responsible for the build, testing, implementation and maintenance of Charge Description Master within the Epic Resolute Hospital Billing application.
• Serves as a subject matter expert to assist with system/process setup for new services. Actively participates in HSCRC taskforces and RVU conversions.
• Supports development, implementation and compliance of Charge Capture policies and procedures necessary to support operations.
• Assesses revenue generating departments, particularly those that are high volume, high revenue, and/or high risk to ensure accurate Charge Capture, and provides recommendations for Revenue Cycle process improvements.
• Works with clinical departments to ensure appropriate charge capture effectiveness and identifies and recommends opportunities for improved standardization and consistency of Charge Capture processes system-wide.
• Actively supports functional or integrated testing of application updates, analyzes written and verbal feedback and communicates changes to staff in a manner that ensures compliance with UMMS CDM/Charge Capture standards.
• Provides technical support to fulfill CDM maintenance, reporting and data analysis requests.
• Responsible for researching Medicare Federal Regulations and Local Coverage Determinations for all service lines. Drafts summaries, billing protocols, and training tools as needed.
• Responsible for the development of system-wide CDM integration and standardization between hospitals CDM master files.
• Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), clinicians, UM School of Medicine, and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
• Keeps abreast of current regulatory information/guidelines and coaches others to do the same; communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance. Participates in HSCRC and industry meetings and workgroups.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Coordinates external HSCRC and other CDM-related regulatory audits to ensure that all information is available and completed on a timely basis.What You Need to Be Successful:
Education and Experience
Bachelor’s Degree required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
• Five years progressively responsible professional financial, reimbursement, or analysis experience is required. In addition, at least one year supervisory/management experience is preferred.
• CDM build/maintenance experience preferred.
Knowledge, Skills and Abilities
• Demonstrated knowledge of HSCRC reimbursement methodologies is required. Knowledge of state and federal reimbursement laws and regulations is required.
• Knowledge of ICD-10 and AMA Current Procedure Terminology (CPT) preferred. AAPC Medical Coding certification may be required.
• Epic Charge Description Master Proficiency may be required.
• Proficiency in preparing and analyzing financial data and implementing changes to contain costs for budgetary purposes.
• Effective at supervising, monitoring daily work activities, evaluating, training and motivating performance of subordinate technical, professional and clerical support staff.
• Effective organizational and problem-solving skills are required to develop/implement efficient work processes and to successfully resolve difficult, conflict-oriented situations.
• Knowledge of charge master components, coding and Epic charge master description application.
• Highly effective verbal and written communication skills are necessary.
• Highly proficient data analysis skills are required. Ability to organize, combine, filter, and perform calculations on large datasets.
• Highly effective computer skills that include the following applications: MS Excel, MS Word, and PowerPoint. Proficiency in Epic, MS Access, SAS, & Tableau is preferred.
• Ability to handle confidential issues with integrity and discretion.
• Ability to work effectively in a stressful work environment.
Working Conditions/Physical Demands
• Position may require flexible work schedule, including night and weekend support of major implementations or major system support efforts.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.