Associate Director, Compliance & Revenue Integrity

Cedars-Sinai Medical Center; United States; On-site; USD 140,000 - 200,000; Full time

Job summary

Cedars-Sinai Medical Center is seeking an Associate Director of Compliance and Revenue Integrity to safeguard revenues across the health system, overseeing charging accuracy, pricing strategies, denial avoidance, and compliant revenue management with a performance-based culture.

You will coordinate with Revenue Cycle, Finance, and clinical departments to drive cost-effective, patient-centered operations; lead strategic initiatives, maintain CDM compliance, and steer denial mitigation and audits

Responsibilities

• Ensures knowledge of trends shaping healthcare Revenue Cycle and regulatory issues.
• Ensures compliance with state and federal laws, accreditation, standards, and Cedars-Sinai policies.
• Monitors productivity and quality benchmarks; drives improvements in compliant revenue management.
• Liaises between Revenue Cycle, Finance, and clinical departments to streamline provider and patient-centric operations.
• Plans and implements process improvements on strategic initiatives with inter-departmental collaboration.
• Maintains and enhances the CDM in compliance with policy and annual plan.
• Establishes denial avoidance feedback loops and participates in workgroups for optimization and mitigation.
• Makes recommendations to improve revenue capture for the organization.

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 times for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company’s Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefits package that includes health care, paid time off, and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.

What you will be doing in this role:

The Associate Director of Compliance and Revenue Integrity (CRI) is responsible for ensuring the integrity of revenues captured and billed across all entities of the health system. This will be accomplished through review and assurance of accurate charging, strategic price setting, use of robust denial avoidance techniques, and oversight of compliant revenue management practices of clinical and department operations clients to create and support best-in-class, patient-focused revenue cycle operations with a metric-driven, performance-based culture of compliance and accountability at all levels.

• Ensures a knowledge and understanding of the trends and forces shaping the health care Revenue Cycle and other active and emerging regulatory issues in healthcare management. Reviews and researches regulatory documentation to ensure our revenue integrity compliance.
• Ensures compliance with state and federal laws, accreditation, professional and regulatory agency standards and licensure requirements. Maintains staff compliance with Cedars Sinai Health System policies, procedures and protocols.
• Monitors goals and benchmarks for productivity and quality standards in conjunction with industry best practices. Identifies potential improvements and moves team to achieve next level of performance with regards to compliant revenue management education, productivity, and best practices.
• Provides coordination and subject matter expertise across their areas of responsibility and will act as a liaison between the Cedars Sinai Revenue Cycle (CSRC), Finance, and clinical departments across the organization in developing streamlined, cost-effective, provider and patient-centric operations that support the integrity of our current and future revenue streams.
• Direct responsibility to plan, organize and implement process and business improvements on designated strategic initiatives. The associate director will collaborate with inter-departmental teams to effect change that is cohesive and embraced by the participants for optimal outcomes.
• Responsible for developing, maintaining and enhancing the CDM in a manner in compliance with Cedars Sinai Health System policy and annual compliance plan.
• Establishes denial avoidance feedback loops and improves operational processes to enhance revenue capture. Participates or leads workgroups and committees to facilitate revenue optimization and denial mitigation initiatives and strategies.
• Make recommendations for improvements and initiatives to support optimal revenue capture for the organization.
• Ensure compliant charging practices exist and are adhered to through consistent review of charge-master services and codes, as well as charge capture and compliance audits, throughout the health system.