Rush University Medical Center
Sys Dir Regulatory and Appeals Integrity
Rush University Medical Center, Chicago, Illinois, United States, 60290
Job Description
Location: Chicago, Illinois
Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: Revenue Cycle Revenue Integrit
Work Type:
Full Time (Total FTE between 0.9 and 1.0)
Shift:
Shift 1
Work Schedule:
8 Hr (7:00:00 AM - 3:00:00 PM)
Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).
Pay Range:
$63.10 - $106.01 per hour
Rush salaries are determined by many factors including, but not limited to, education, job‑related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.
Summary The director of revenue cycle regulatory & payor policy integrity, working in a remote environment, will lead revenue cycle regulatory optimization for all Rush facility and professional claims to promote accuracy and foster appropriate reimbursement. The position will lead audit and denials tracking, appeals, and prevention related to charges and coding. This leader promotes a positive culture, efficiency and the use of Epic automation and ancillary software solutions along with exemplifying the Rush mission, vision and values and act in accordance with Rush policies and procedures.
Required Job Qualifications
Bachelor’s or Associate degree in health information technology, healthcare management, nursing, finance, or other related fields.
AHIMA or AAPC Certification (such as CCS, CCA, CPC, COC, CPMA, RHIT or RHIA)
Five years of leadership experience
Ten years of experience with coding or revenue integrity in hospital (HB) or professional (PB) Epic work queues, along with ICD-10/CPT/HCPCS codes, Modifiers, NCCI edits, and compliant coding methodologies
Experience with Epic reporting and dashboards
Demonstrated ability to communicate clearly and effectively
Proficient in Microsoft Office, Excel, PowerPoint, and Word skills
Strong interpersonal skills necessary for the communication and training of Revenue Integrity concepts
Ability to perform multiple tasks with excellent time management skills
Preferred Job Qualifications
Masters degree
Epic Certified
Disclaimer The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
Responsibilities
Lead and direct regulatory integrity staff while acting as a resource for the team’s work of connecting regulations, compliance standards, and payor policy to revenue codes, modifiers, ICD-10, CPT/HCPCS, and other codes, with clinical documentation, to ensure accurate claims.
Improve revenue results and ensure adherence to federal state and payor regulations while driving compliance by ensuring Epic configuration is compliant, charging and coding regulations are applied, and the middle revenue cycle initiatives are carried out per the revenue cycle goals and KPI’s.
Keeps abreast of changing industry and regulatory requirements and communicates changes to impacted leaders, staff, while collaborating with other areas and Epic for coding, charging, reimbursement, quality, or clinical documentation issues, to solve, maintain a record of issues, and communicate solutions and improvements.
Prevent denials by directing staff to analyze and use code knowledge to identify trends and create solution strategies.
Ensure denied claims related to middle revenue cycle are followed up on and appealed in an appropriate manner.
Track payor audit behavior and accounts to ensure timely follow-up and appeals across revenue cycle.
Proactively lead efforts to identify regulatory trends, opportunities within Rush, and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance automation, prevent denials, train staff, ensure timely claims submission, and promote accuracy using short-term and long-term planning.
Monitor industry trends, denial trends, and documentation patterns to inform training needs and process enhancements and then collaborate with projects teams to innovate solutions.
Partner with Compliance, legal, and Internal Audit to optimize Rush’s regulatory adherence in revenue cycle.
Partner with Revenue Cycle leaders to track and positively impact KPI’s and revenue impact related to coding accuracy and compliance.
Collaborate with Epic D&IS teams and ancillary software vendors to optimize documentation workflows and ensure efficient operations across revenue cycle.
Develop, update and implement job standards, job duties, job aids, departmental policies, and performance appraisals for all areas of responsibility. Engages in development and growth of self and the team.
Collect, interpret, and communicate performance data using various tools and systems, while also using this data to make decisions on how to achieve performance and budgetary goals.
Responsible for interviewing, hiring, orienting new team members (staff & temp), staffing, performance management and development of staff. Counsel and disciplines employees, when necessary, in accordance with department and/or organizational policies. Maintains staff schedules, timecards, and payroll with fiscal responsibility.
Prepares monthly analytics reports, dashboards information, and other statistics along with forecasting, strategic planning, and budgeting.
Facilitate a positive culture that exemplifies growth‑minded practices, leadership, and industry‑best practices.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position: Sys Dir Regulatory and Appeals Integrity
Req ID: 22641
#J-18808-Ljbffr
Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: Revenue Cycle Revenue Integrit
Work Type:
Full Time (Total FTE between 0.9 and 1.0)
Shift:
Shift 1
Work Schedule:
8 Hr (7:00:00 AM - 3:00:00 PM)
Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).
Pay Range:
$63.10 - $106.01 per hour
Rush salaries are determined by many factors including, but not limited to, education, job‑related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.
Summary The director of revenue cycle regulatory & payor policy integrity, working in a remote environment, will lead revenue cycle regulatory optimization for all Rush facility and professional claims to promote accuracy and foster appropriate reimbursement. The position will lead audit and denials tracking, appeals, and prevention related to charges and coding. This leader promotes a positive culture, efficiency and the use of Epic automation and ancillary software solutions along with exemplifying the Rush mission, vision and values and act in accordance with Rush policies and procedures.
Required Job Qualifications
Bachelor’s or Associate degree in health information technology, healthcare management, nursing, finance, or other related fields.
AHIMA or AAPC Certification (such as CCS, CCA, CPC, COC, CPMA, RHIT or RHIA)
Five years of leadership experience
Ten years of experience with coding or revenue integrity in hospital (HB) or professional (PB) Epic work queues, along with ICD-10/CPT/HCPCS codes, Modifiers, NCCI edits, and compliant coding methodologies
Experience with Epic reporting and dashboards
Demonstrated ability to communicate clearly and effectively
Proficient in Microsoft Office, Excel, PowerPoint, and Word skills
Strong interpersonal skills necessary for the communication and training of Revenue Integrity concepts
Ability to perform multiple tasks with excellent time management skills
Preferred Job Qualifications
Masters degree
Epic Certified
Disclaimer The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
Responsibilities
Lead and direct regulatory integrity staff while acting as a resource for the team’s work of connecting regulations, compliance standards, and payor policy to revenue codes, modifiers, ICD-10, CPT/HCPCS, and other codes, with clinical documentation, to ensure accurate claims.
Improve revenue results and ensure adherence to federal state and payor regulations while driving compliance by ensuring Epic configuration is compliant, charging and coding regulations are applied, and the middle revenue cycle initiatives are carried out per the revenue cycle goals and KPI’s.
Keeps abreast of changing industry and regulatory requirements and communicates changes to impacted leaders, staff, while collaborating with other areas and Epic for coding, charging, reimbursement, quality, or clinical documentation issues, to solve, maintain a record of issues, and communicate solutions and improvements.
Prevent denials by directing staff to analyze and use code knowledge to identify trends and create solution strategies.
Ensure denied claims related to middle revenue cycle are followed up on and appealed in an appropriate manner.
Track payor audit behavior and accounts to ensure timely follow-up and appeals across revenue cycle.
Proactively lead efforts to identify regulatory trends, opportunities within Rush, and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance automation, prevent denials, train staff, ensure timely claims submission, and promote accuracy using short-term and long-term planning.
Monitor industry trends, denial trends, and documentation patterns to inform training needs and process enhancements and then collaborate with projects teams to innovate solutions.
Partner with Compliance, legal, and Internal Audit to optimize Rush’s regulatory adherence in revenue cycle.
Partner with Revenue Cycle leaders to track and positively impact KPI’s and revenue impact related to coding accuracy and compliance.
Collaborate with Epic D&IS teams and ancillary software vendors to optimize documentation workflows and ensure efficient operations across revenue cycle.
Develop, update and implement job standards, job duties, job aids, departmental policies, and performance appraisals for all areas of responsibility. Engages in development and growth of self and the team.
Collect, interpret, and communicate performance data using various tools and systems, while also using this data to make decisions on how to achieve performance and budgetary goals.
Responsible for interviewing, hiring, orienting new team members (staff & temp), staffing, performance management and development of staff. Counsel and disciplines employees, when necessary, in accordance with department and/or organizational policies. Maintains staff schedules, timecards, and payroll with fiscal responsibility.
Prepares monthly analytics reports, dashboards information, and other statistics along with forecasting, strategic planning, and budgeting.
Facilitate a positive culture that exemplifies growth‑minded practices, leadership, and industry‑best practices.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position: Sys Dir Regulatory and Appeals Integrity
Req ID: 22641
#J-18808-Ljbffr