Revenue Integrity Compliance Director in Nashville at Parallon

Date Posted: 11/6/2018

Job Snapshot

Job Description

Revenue Integrity and Compliance Director


Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.


Job Summary – The Corporate Chargemaster and Revenue Integrity Director for Parallon Business Performance Group (“BPG”) is primarily responsible for ensuring adherence to HCA chargemaster standards and billing compliance initiatives for new acquisitions as a member of the Parallon Corporate Compliance team. The Director must be able to support BPG with knowledge of billing regulations, coding regulation as well as Medicare and other payor specific regulations. This individual will work collaboratively with cross functional teams to support new acquisitions to ensure appropriate chargemaster mapping and compliance with HCA standards. In addition the Director will provide oversight to support appropriate revenue capture education and monitoring for new acquisitions. The Director will perform due diligence on new acquisitions chargemaster and revenue capture practices and determine corrective actions, including educational opportunities, mapping opportunities, and communicating these activities to the Leadership at BPG Corporate Compliance,  SSCs, Facility, Division, and Regulatory Compliance Support Department.  The individual will participate in acquisition teams and serve as the responsible party with oversight of Chargemaster mapping activities as well as compliance to Regs standards.  In addition, the Director will develop, implement, and manage the Parallon revenue capture analysis and prebill capture program. This program will be responsible for capturing potential revenue capture that is compliant with billing and Medicare regulation in addition to being compliant with HCA billing and coding guidance.


This individual must demonstrate a strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. They must have an extensive background in hospital coding, billing and regulatory requirements, CPT/HCPCS, Revenue Codes and managing professional resources. This individual will be working hand in hand with the Parallon Corporate Compliance leadership in developing the future strategy and prioritization of Masterfile management in addition to revenue capture compliance initiatives. This individual must have a strong understanding of system integration and revenue cycle.


Duties:

  • Supervise the Manager(s) of Corporate Revenue Integrity and Chargemaster Compliance as well as the Corporate Compliance Analyst.
  • Support acquisitions with oversight of all chargemaster related activities including monitoring deadlines and compliance mapping to HCA standards (25% travel possible pending on acquisition activity).
  • Oversee development of data analytics to help support compliance monitoring of chargemaster for new acquisitions in addition to evaluating appropriate revenue capture analytics.
  • Communicate relevant company billing and coding decisions to all relevant parties in response to acquisition management; including but not limited to action plan management.
  • Responsible for developing and maintaining positive relationships with key stakeholders including but not limited to CRM team, Corporate Compliance team, Corporate Functional Area Leaders, HIS team, IT&S team, Regs, SSC Leadership, ECOs, CDM Managers, RI Leadership, project management.
  • Develop a Company strategy to support masterfile mapping; including policy and procedure development and education plan development.
  • Develop a Corporate strategy to support prebill charge capture review.
  • Monitor compliance of charge capture and work closely with revenue integrity staff to support education to hospital departments.
  • Work closely with HCA Corporate Regs team to ensure compliance with billing and coding standards.



Job Requirements

EDUCATION

  • Bachelor’s Degree in Healthcare or related Business field preferred.
  • Equivalent work experience may substitute degree requirement


EXPERIENCE

  • Minimum 7 years of chargemaster, revenue integrity, charge capture auditing or coding experience in a health care setting required.  HCA experience preferred.
  • Minimum 5 years’ management level experience.
  • Understanding of PA Masterfile linkage preferred.
  • Minimum 3 years’ using analytics in management role such as Microstategy Visual Insights, Tableau, Excel or other analytic resources experience required.


 
CERTIFICATE/LICENSE

  • RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT preferred
  • Certified Healthcare Compliance preferred