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Billing/Coding Sr Manager - Revenue Integrity

Company: Kaiser Permanente
Location: Pasadena
Posted on: February 10, 2020

Job Description:

The Senior Manager, Business Risk Management is a Revenue Cycle recognized content expert in healthcare finance and regulatory compliance, as well as the Regional lead for a wide-range of Revenue Integrity requirements applicable to KP's nondues Revenue Cycle, across Southern California and other regions as required. The Manager takes a leadership role in the development and implementation of Revenue Cycle Revenue Integrity goals, works to ensure consistency within fee-for-service billing practices, and supports accurate claims submission and maximum reimbursement. This requires a comprehensive understanding of billing and reimbursement requirements, including Medicare and Self-Funding, and a recognized ability to understand and navigate the delicate balance between maintaining the highest standards of quality, integrity and compliance while minimizing hindrances to operational efficiency.Provides leadership and direct management of all Quality Management Reviewers, Hospital Coding Reviewers, and will be responsible for developing and maintaining consistent review procedures following a standardized consensus on accuracy measures. The role involves being able to present review findings to Operational, Clinical, and Technical leaders, along with recommendations for appropriate 'next steps' for remediation.Essential Responsibilities:

  • Oversees a series of core reviews targeted to identify Professional, Hospital, and Hospice coding accuracy, billing accuracy, and finalized claim accuracy for all lines of business.
  • Provides strategic planning and direction for the development and enhancement of billing and coding reviews including partnership with key stakeholders in hospital, professional, hospice, and other settings in SCAL, GA, and other regions as identified. Ensures a high quality and consistency of the reviewing and monitoring processes across multiple venues.
  • Direct supervision and oversight of a team of billing quality reviewers (HB/PB/Hospice), a team leader responsible for the Corrective Action Plans and other process improvement initiatives, and provides direct leadership to teams of billing quality reviewers and hospital coding reviewers. Provides oversight, leadership, and technical direction to team members and helps to mentor and grow the skillsets of the team.
  • Oversees the review process and to ensure that all of the billing quality reviewers have a standardized approach. Responsible for evaluating finalized claims to identify and track issues related to billing, coding, system functionality, clinical documentation, and regulatory needs identified on finalized claims.
  • Responsible for partnering with coding and operational leadership, training, and review teams to ensure standardized methodology for evaluating the CPT, Diagnoses, POA, and other relevant coding on hospital chart.
  • Provides management and oversight to the Corrective Action Plan (CAP) process of working to resolve known compliance issues within Revenue Cycle by (a) conducting a root cause analysis (b) working with stakeholders to address and correct root cause issues (c) documenting remediation. Further the role will have oversight of the Charity Care SOX review.
  • Provides leadership for the team workflow (the Quality Management Team does the SOX review) to meet critical guidelines with needed SOX reporting as well as QMR reporting. Provides guidance to teams in how to assess certain charity care form entries to determine whether or not those entries meet the expected criteria. Develops standardized review approaches and tracking mechanisms. Responsible for partnering with Operational Leadership in addressing findings, and guiding them to take remediative action to prevent further errors.
  • Develops and reports out on the combined findings for different quality reviews and helps not only to identify common issues but make recommendations on appropriate steps for remediation.
  • Serves as a subject matter expert on regulatory and coding guidelines, participating in meetings and in general supporting Revenue Cycle initiatives by contributing time and opinions from an operational and compliance viewpoint.
  • Participates in stakeholder meetings where differing opinions may be the norm and provides thoughtful input on how to obtain a common ground. Responsible for providing guidance in issues of dispute, and helping to guide the teams to attain a higher level of communication with each other and with stakeholders.
  • Monitors process improvements related to compliance and revenue opportunities and takes a leadership role in informing stakeholders and providing solutions.
  • Interfaces with Med Group (SCPMG and occasionally PMG), Legal, Revenue Cycle Senior Leadership, PFS Leadership, Compliance (National, Regional, and Med-Center levels), Internal Audit, IT, SSD, and other stakeholders as necessary to ensure smooth communication and problem resolution. Note that this participation includes interactions with Georgia and other regions as the need arises.
  • Promotes a positive and inclusive team environment in which doors are open and problems are addressed in a collegial and supportive manner.
  • Advises on new charge capture initiatives, and further provide review and guidance for other regions as they implement new charge capture and/or new processes.
  • Serves as a subject matter expert and will be called upon to provide his/her opinion on issues related to coding, billing, and operational compliance.Basic Qualifications:Experience
    • Minimum of five (5) years of progressive experience within a healthcare environment, including three (3) years supervision or project management.Education
      • Bachelor's degree in Finance, Accounting, Health Care Administration, Public Health Administration, Health Information Management, Business Administration, Information Systems, or other related field; or four (4) years of directly related experience.
      • High School Diploma or General Education Development (GED) required.License, Certification, Registration
        • N/AAdditional Requirements:
          • Must be proficient in procedural and diagnostic coding, especially as it relates to Medicare and Medicaid.
          • Strong background in Healthcare Finance, Compliance, Information Management, or Audit required.
          • Extensive knowledge and demonstrated expertise within healthcare delivery systems, with particular emphasis on revenue cycle activities, including billing requirements and payment methodologies for physician and/or hospital medical services.
          • Understanding of physician and hospital billing and coding practices (CPT, ICD10, APCs, and DRGs, etc.).
          • Working knowledge of government regulations pertaining to HMOs, providers, and to Medicare/Medicaid.
          • Proven ability to effectively communicate both verbally and in writing with parties who may have different and/or conflicting interests and interpretations.
          • Superior skills in conflict resolution and meeting facilitation and project management.
          • Certification in Coding, HFMA, or other healthcare related skillsets.Preferred Qualifications:
            • Preferred candidate would possess a strong healthcare background, including one or more of the following competencies: revenue cycle management, regulatory compliance, and/or audit.
            • Master's degree in Finance, Accounting, Health Care Administration, Public Health Administration, Health Information Management, Business Administration, Information Systems, or other related field.Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.COMPANY: KAISERTITLE: Billing/Coding Sr Manager - Revenue Integrity -LOCATION: Pasadena, CaliforniaREQNUMBER: 860978External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Keywords: Kaiser Permanente, Pasadena , Billing/Coding Sr Manager - Revenue Integrity, Accounting, Auditing , Pasadena, California

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