Under the direction of the Chief Compliance & Privacy Officer (CCPO), the Director of Revenue Cycle Compliance is responsible for directing, developing and implementing the UC San Diego Health Revenue Cycle Compliance program. Responsible to the CCPO for assuring that the key elements of an effective revenue cycle compliance program are in place and operationalized as it relates to the Corporate Compliance Unit (e.g., policies, education, risk assessments, profiling, work plan, monitoring, reporting and corrective/remedial actions and daily operations). Serves as a resource for focused compliance programs. In consultation with the CCPO, identifies compliance issues, interprets relevant laws, statutes and policies governing compliance issues, and coordinates and/or leads projects or policy redesigns to accomplish compliance with the laws applicable to the UCSDHS enterprise. Assures that operations leverages leading practice industry standards and meet all regulatory and compliance requirements. Oversees planning, preparation and presentations of budgets that demonstrates prudent use of the organization's resources while at the same time achieving and maintaining organizational goals and key performance indicators. The goals of the Revenue Cycle Compliance program are to further the UCSDHS mission of providing quality health care to our patients, while at the same time, advancing the prevention of fraud, waste and abuse in our health care delivery system.
Juris Doctor degree
Five (5) years of progressively responsible experience in healthcare law and/or compliance.
Experience and demonstrated ability to consistently interact and negotiate with all members of the organization in ways that enhance understanding, respect, cooperation and problem-solving.
Demonstrated knowledge, skills, or ability to work independently, manage multiple activities simultaneously, solve problems, and set priorities for self and others.
Experience developing operating procedures and processes.
Demonstrated ability to: (a) Identify key issues critical to the success of a desired product/outcome; (b) Quickly research and analyze data; (c) Integrate essential information; (d) Utilize the analysis to define and test options and alternatives; and (e) Develop recommendations and justification for the most productive course of action.
Knowledge of current federal and state health care revenue cycle laws and regulations, including: Medi-Cal, and other third-party payers billing guidelines (professional fee and hospital billing).
Experience counseling sophisticated health care provider entities and executive leaders in sensitive matters.
Working knowledge of medical coding and billing procedures, teaching physician regulations, professional fee billing, and hospital facility billing, including CPT coding, ICD 9 and 10, modifiers, DRG's, APCs.
Knowledge and experience writing, developing and implementing policies, procedures, and standards of conduct related to health care revenue cycle issues.
Experience designing work plans for revenue cycle compliance program, conducting monitoring to assess compliance with revenue cycle policies and audits.
Experience enforcing policies.
Experience overseeing and documenting external regulatory procedures, investigations and audits related to revenue cycle.
Knowledge of and experience with conducting internal monitoring and auditing; and responding promptly to detected offences, developing corrective action plan, and reporting findings to Government agencies via established channels.
Experience ensuring implementation of new rules, regulations and decisions as set forth by CMS as well as other applicable federal, state laws.
Ability to lead a team during a complex and constantly changing environment.
Chairs and/or participates in committees or boards related to revenue cycle compliance.
Must be insightful and possess creative skill in reasoning and logic, as well as quantitative analysis.
Experience collaborating with key leadership, other employees, contractors, and independent physicians to identify, research, investigate and resolve compliance issues dedicated to medical center revenue cycle compliance.
Experience interpreting, writing and implementing policies and with conducting surveillance audits.
Demonstrated project management and organizational skills.
Utilizes proper resources to effect change and proposes those changes up the proper channels by way of clear and concise verbal and/or written language.
Self-starter, motivated, disciplined and diplomatic professional with high energy and a strong work ethic; a team player who will work for both short and long term goals of the organization and who can resolve a
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