Special Selection Applicants: Apply by 03/30/2022. Eligible Special Selection clients should contact their Disability Counselor for assistance.
UC San Diego Health's Revenue Cycle supports the organization's mission to deliver outstanding patient care and to create a healthier world — one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients.
The Director Revenue Integrity promotes the financial viability of the UCSD Health System 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. The Director Revenue Integrity works collaboratively with revenue generating departments and providers in the development, execution, and follow up education to physicians and clinicians related to charging and billing compliance. Acts as a central point for disseminating information and guidance related to the charging of services, supplies and pharmaceuticals. Identifies ways to improve work processes, enhance quality, productivity, and service delivery.
Responsible for personnel management, resource management, quality assurance of the UCSD Revenue Integrity staff including Charge Capture and Charge Description Master Workload to ensure Charge Description Master Activities are executed accurately and efficiently. Ensures adherence to established policies, government regulations and payor requirements. This position reports directly to the Chief Revenue Cycle Officer.
Drives the implementation of programs, policies, initiatives, and tools for Charge Capture, including but not limited to institutional system-wide charge capture processes to ensure efficiency and effectiveness
Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities
Development of action plan with responsible parties and due dates of issues identified
Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms
Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue
Collaborates with Clinical Physician Leaders and Departments to review new technologies and establish related charge capture and coding protocols
Directs and facilitates the development of corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. This includes evaluation and identification of root causes resulting in charge capture deficiencies or lack of revenue recognition
Reviews revenue for potential system optimization/enhancements to ensure consistent charge capture, including revenue guardian rules, claim edits and DNBs to act as stop gap measures for revenue leakage
Develops and executes Charge Audit Approach identifying department(s) for review including chart documentation on a regular basis to verify the clinical documentation supports the charges billed, prepare a summary report of findings, and share with department leadership. Oversees CDM Annual Audit and Charge Capture Audit
Develops and monitors KPIs related to charging practices and reports metrics to revenue generating department leadership
Directs the design/redesign of CDM processes and systems to improve service and data integrity
Maintains oversight of Charge Master Development, working closely with Revenue Generating Clinical Departments to ensure that coding, revenue codes, description nomenclature patient billable vs. non-billable, catalog development and updates (add/delete/change) for all CDM items are appropriate, verified through monthly feedback from Executive Leadership
Ensures annual department CPT/HCPCS coding and CDM maintenance updates coincide with the CMS annual updates to the Hospital Outpatient Prospective Payment System
Reviews existing processes to ensure proper controls are in place for the maintenance and reconciliation of CDM updates utilizing CDM Manager
Ensure annual CDM Pricing is updated and implemented
Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication across the enterprise
UC San Diego is an academic powerhouse and economic engine, recognized as one of the top 8 public universities by U.S. News and World Report. Innovation is central to who we are and what we do. Here, students learn that knowledge isn't just acquired in the classroom - life is their laboratory. UC San Diego's rich academic portfolio includes six undergraduate colleges, five academic divisions and five graduate and professional schools. The university's award-winning scholars are experts at the forefront of their fields with an impressive track record for achieving scientific, medical and technological breakthroughs.