About this role
Job Function Summary
Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting and support. Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services. Impacts processes to include charge capture, coding, insurance identification, data entry, billing, payment posting, refund processing and collections. May also be responsible for / integrated with business office operations.
Generic Scope
Technical leader with a high degree of knowledge in the overall field and recognized expertise in specific areas; problem-solving frequently requires analysis of unique issues / problems without precedent and / or structure. May manage programs that include formulating strategies and administering policies, processes, and resources; functions with a high degree of autonomy.
Custom Scope
The individual in this position manages the department’s documentation integrity responsibilities in conjunction with the UCSF Health Faculty Practice Revenue Management Organization (FPRMO) and Clinical Practice Group (CPG) at ZSFG and provides analytical support to the DEM leadership team. Leads projects and / or team members, proposes new programs and policies in accordance with best practices. Manages projects at all levels of complexity and scope.
This position requires the incumbent to have a high degree of independent decision making ability, organization, initiative, ability to prioritize work and various tasks accurately and independently, sensitivity, ability to interact with many diverse personalities and to function effectively under the stress of competing priorities; advanced technical skills, attention to detail, efficient use of time management and the ability to perform with little or no supervision is a must.
Assignments are often given on a project-basis and the incumbent is expected to manage the entire problem-solving process: gather and sort information, identify potential solutions and present the finished product in the form of a written recommendation or completed project.
In addition, it is the responsibility of the incumbent to apply certain knowledge and training expertise to anticipate issues before they arise, reprioritize as events change, anticipate the needs of involved parties and initiate action independently to resolve those issues and solve problems. This position requires a high level of professionalism and diplomacy.
Department Overview
The Department of Emergency Medicine (DEM) provides emergency medical care to over 177,000 patients annually at the UCSF Medical Center at Parnassus, UCSF Benioff Children’s Hospitals at Mission Bay and Oakland and Zuckerberg San Francisco General Hospital and Trauma Center.
DEM administrative and research staff supports the work of 93 full-time and 50+ attendings, a residency program, fellowship programs and over 300 housestaff and students each year.
Our vision is to be the leader in compassionate, innovative and equitable emergency care for all people at all times.
Professional Fee Coding Operations and Management
- Participates in the establishment of quality standards, expectations, and benchmarks for billing and collections documentation. Design models, using input from departments, operational experience, and best practice research. Statistical and financial results in revenue cycle departments and on the workflows and system efficiencies of revenue cycle functions.
- Collaborates with clinical, technical, administrative, and financial leaders to develop or improve documentation workflows across departments to support strong revenue management.
- Oversees review of physician documentation at DEM sites, identifies non-compliant charts and communicates with physicians for timely completion to maximize reimbursement and ensure all documentation is compliant and accurately reflects care delivered.
- Manages compliance activities including providing education and training to faculty and staff, regular updating on changing coding rules and regulations, which requires staying current on University Compliance Office guidelines, CMS rules and regulations and insurance payer policies and requirements, along with an understanding of ED organization and workflow.
- Performs chart review audits at all DEM sites as needed and proposes plans and strategies for remediation and improvement.
Revenue Cycle Strategy and Optimization
- Analyzes highly-complex financial data and identifies trends in revenue cycle functions and operations. Delivers comprehensive reports and presentations to leadership, to include proposals and solutions to maximize revenues.
- Leads and / or monitors progress and priorities on projects. Collaborates with departments across the system to assimilate and define needs, develop goals and metrics, and define system requirements and capabilities.
- Serves as a technical leader and resource in evaluating revenue cycle workflows to propose improvements in efficiencies and timeliness. Provides guidance and expertise in the development of highly-complex workflow improvements to integrate practices in all revenue cycle areas and maximize revenues.
- Recommends and implements new processes and systems to improve charge integrity, reconciliation and charge linkages from ancillary charging systems for the medical center / health system.
Revenue Cycle Compliance
- Develops and implements changes to systems, policies and procedures to maintain currency in government regulations, reimbursement issues and other matters having potential financial impact.
- Keeps abreast of changes in government regulations and requirements of all third party carriers. Provides information about trends, best practices and internal or external compliance issues.
Required Qualifications
- Minimum 5 years of related experience.
- In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
- In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle.
- Advanced organizational and project management skills, and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule.
- Advanced skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software.
- Advanced communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations to all levels of staff and management.
- Advanced analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems in revenue cycle program areas, to identify weaknesses and develop innovative solutions and process improvements.
- Advanced interpersonal skills, with the ability to collaborate effectively on highly-complex projects in a team environment with a wide variety of business and clinical areas.
- Strong ability to advise management, serving as a technical expert, providing proposals for improvement and guidance on regulatory changes and industry trends and developments in revenue cycle management.
Required Education
- Bachelor's degree in related area and / or equivalent experience / training.
Preferred Education
- Master’s degree in a related area and/or equivalent experience / training.
Required Certification
- Certified Professional Coder (CPC).
Licenses
None listed.