Job Description
Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.
What you be doing in this role:The Manager, Compliance and Revenue Integrity (CRI) manages one or more functions within the Compliance and Revenue Integrity organization. They are responsible for the strategic and operational oversight of their assigned function(s) including overseeing staff, developing policies, procedures, and workflows to ensure maximum efficiency and accuracy. They are also responsible for data integrity and provide strategic analysis of data/reports, conveying findings and making recommendations to senior leadership.
- Areas of assigned responsibility may include managing the processes for charge capture, charge reconciliation, charge maintenance, pricing strategy, CDM/fee schedules (hospital and professional fee/clinic pricing), charge tickets creation and maintenance, charge edits, clinical denials, revenue-related audits, revenue cycle regulatory monitoring and compliance, and multidisciplinary clinical, operational, and financial revenue practice teams.
- Responsible for evaluating finalized claims, adjustments, complex customer concerns, and audits to identify and track issues related to billing, coding, system functionality, clinical documentation, and regulatory needs.
- Develops and reports out on findings for different quality reviews and helps not only to identify common issues but make recommendations on appropriate steps for remediation.
- Monitors process improvements related to compliance and revenue opportunities and takes a leadership role in informing partners and providing solutions.
- Serves as a subject matter expert and will be called upon to provide opinion and guidance on issues related to coding, billing, and operational compliance.
- Manages, coordinates, and champions multiple revenue cycle initiatives across the organization (PB/HB) to improve processes and support optimal high-performing revenue cycle operations.
- Oversight of the team managing the Medicare and Medicaid RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates to Compliance, Utilization Review, and Finance leadership. Partners with internal counsel and external vendors during all levels of the appeal process including settlement conferences and trials. Maintains and monitors high success rates in the audit program.
- Provides reporting and feedback to Revenue Cycle and clinical operations collaborators to support correct and compliant documentation, coding, charge capture and billing across the system for all hospital and professional services patient accounts and locations.
- This role partners with departments to reduce revenue leakage through impact studies, revenue reviews, and industry best practice.
- May manage assigned teams for the optimization of net revenues.
- Responsible and accountable for implementing revenue capture strategies and ensuring efficient and compliant revenue processes which ensure that the organization collects all revenue to which it is entitled while maintaining compliance.
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Qualifications
Requirements:
- Bachelor's degree in business, economics health or a related major required.
- Coding or health care compliance certifications and Epic certifications preferred.
- A minimum of 5 years of experience in revenue cycle, revenue integrity or billing experience in a hospital based or medical office setting required.
- 5 years or more of proven experience in revenue cycle, revenue integrity or billing experience in multi-specialty medical group or medical office setting preferred.
- Management and supervisory experience preferred.
Why work here?
Beyond outstanding employee benefits including health and dental insurance, vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.
Req ID : 5218
Working Title : Manager, Compliance & Revenue Integrity
Department : CSRC Dir Compliance and Rev Mgt
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Financial Services
Job Specialty : Revenue Integrity
Overtime Status : EXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $46.35 - $81.11
Our compensation philosophy
We offer competitive total compensation that includes pay, benefits, and other recognition programs for our employees. The base pay range shown above takes into account the wide range of factors that are considered in making compensation decisions including knowledge/skills; relevant experience and training; education/certifications/licensure; and other business and organizational factors. This base pay range does not include our comprehensive benefits package and any incentive payments that may be applicable to this role. Pay Transparency Non Discrimination Provision (PDF) (opens in new window)
Diversity and Inclusion at Cedars-Sinai
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve – because that’s what our patients, colleagues and communities deserve. Quality Care and Research—For All, By All (opens in new window).
Cedars-Sinai is an Equal Employment Opportunity employer.
Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy. Cedars-Sinai’s AA Policy Statement (PDF) (opens in new window)
