Associate Director, Revenue Integrity & Compliance Excellence

Cedars-Sinai; Los Angeles (CA); On-site; USD 140,000 - 180,000; Full time

Job summary

Cedars-Sinai is seeking an Associate Director of Compliance and Revenue Integrity to ensure accurate charging and compliant revenue management across the health system. You will oversee charge-master practices, engage with clinical departments, and lead initiatives to optimize revenue capture with a data-driven, compliant culture.

The role requires a healthcare background, 5+ years of progressive experience, and relevant EPIC or compliance certifications.

Qualifications

• Bachelor's degree required; master's preferred.
• Minimum 5 years of progressive healthcare experience.
• EPIC HB/PB certifications preferred.
• Coding or Compliance certificates preferred.

Responsibilities

• Ensures integrity of revenues captured and billed across the health system.
• Reviews regulatory documentation to ensure revenue integrity compliance.
• Monitors productivity and quality standards, driving improvements to revenue management practices.
• Acts as liaison between Revenue Cycle, Finance, and clinical departments to streamline operations.
• Leads initiatives to enhance denial avoidance and compliant charge practices.

Skills

Healthcare operations knowledge

Regulatory compliance

Process improvement

Education

Bachelor's degree in business administration/health

Master's degree preferred

Tools

EPIC HB certification

EPIC PB certification

AHIMA/AAPC/HCCA certificate

Job description

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.

Qualifications

Requirements:

• Bachelor's degree in business administration, health or a related major required. Master's degree preferred.
• A minimum of 5 years of progressive healthcare experience required.
• EPIC Certifications in HB and PB preferred.
• Coding or Compliance Certificate (AHIMA, AAPC, HCCA) 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.