As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Director, Revenue Cycle Compliance contributes to Conifer Healthï¿½s (Conifer) mission by providing both strategic and day-to-day leadership to the compliance program designed to ensure Conifer fully complies with its Code of Conduct and all applicable laws and regulations. The Compliance Director supports Coniferï¿½s Ethics and Compliance program by providing revenue cycle compliance consultation and guidance in the following areas:, Monitoring and Oversight, Regulatory Change Management, Vendor Oversight, Investigations/Client Engagement, Training and Education, and Policy and Procedure Development and Governance.
The Director, Revenue Cycle Compliance, assists in implementing, and overseeing the compliance program by (1) ensuring there is an effective risk-based compliance program and oversight in place to remain compliant with all applicable local, state, and federal healthcare rules and regulations, (3) when appropriate, leading and developing team members to support programmatic efforts, and (4) functioning as a revenue cycle compliance subject-matter expert for Coniferï¿½s operational service lines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Functions as a revenue cycle compliance subject-matter expert for:
ï¿½Responding to revenue cycle-related questions
ï¿½Overseeing and, at times, conducting revenue cycle-related monitoring activitiesand
ï¿½Providing consultative guidance on compliance investigations.
Participates in the development and implementation of the Revenue Cycle Compliance portion of Coniferï¿½s Annual Ethics and Compliance work plan.
ï¿½Reviews and advises on risk assessment findings
ï¿½Oversees and/or performs Work Plan-related reviews and projects by defining review/projects scopes and processes; gathering and analyzing data; and documenting findings.
ï¿½Drafts meaningful audit reports.
ï¿½Collaborates with Operations to develop and implement effective corrective action plans.
Routinely uses data analytics to identify and address potential compliance risks.
Monitors, analyzes, and interprets regulatory changes related to revenue cycle. Assists in overseeing the efforts to respond to new or changing regulations, including but not limited to communicating regulations to leadership and affected departments, and participating in implementation work teams.
Advises on and develops policies and procedures related to revenue cycle compliance.
Collaborates with key leadership, team members, contractors and other stakeholders throughout Conifer to promote a culture of compliance.
Participates in strategic planning efforts related to the revenue cycle compliance function
Identifies and implements revenue cycle compliance-related education designed to reduce overall compliance risk for both Conifer and the clients we serve.
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (titles):Manager, Senior Specialist, and/or Specialist as applicable
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to work independently with little supervision and seek guidance as needed to clarify assignments or request for information.
Excellent communication, customer service and time-management skills
Strong team-building and development skills
Possess basic business skills, an understanding of general compliance operations and department goals in the healthcare environment.
Proficient with various desktop applications such as Microsoft Excel, Word, PowerPoint and/or Access.
Intermediate knowledge of relational database management systems
Must be a positive team player - Always willing to help in whatever way possible and go the extra mile to get the job done.
Intuitive and skilled at problem solving in anticipation of team member and client requests
Have the ability to make logical correlations between data points to determine if analysis is accurate
Detail oriented, meticulous and accurate in completing tasks on time.
Revenue Cycle Compliance Director Specifics:
Monitors, analyzes, interprets, and communicates regulatory changes related to coding, billing, and collections. Leads and oversees efforts to respond to new or changing regulations, including but not limited to communicating regulations to leadership and affected departments, assembling and chairing work teams.
Supports the process for investigating and addressing internal/external complaints regarding regulatory requirements.
Ensures compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS), as well as other federal and state laws and regulations that govern matters related to hospital and physician revenue cycle.
Oversees the follow-up to ensure timely repayment is made for all identified overpayments received from government agencies and patients.
Oversees the development and implementation of compliance policies and procedures related to the organizationï¿½s hospital and physician revenue cycle.
Reduces organization risk by identifying risks related to hospital and physician revenue cycle and manage annual work plan to address identified risks.
Contributes to the annual compliance monitoring plan and oversee the components related to hospital and physician revenue cycle activities.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Masterï¿½s Degree in Business, Information Systems, Health Care Administration; Juris Doctorate or related field or equivalent years of related Manager Experience required.
Minimum of five (5) yearsï¿½ experience in related area with two of these years being healthcare management or healthcare compliance.
Include minimum certification required to perform the job.
Variety of billing and/or coding certifications are preferred
Certified Healthcare Compliance (CHC) is preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to Travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Hospital Work Environment
Up to 20%
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905030981
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.