Director of Revenue Integrity I/II

Under general direction, the The Director of Revenue Integrity I/II provides management of a department, or across several departments, operations and services within the Health Care Agency. The Director of Revenue Integrity I/II is responsible for the management of administrative and managerial functions and develops department goals, strategic plans, and long-term vision, and makes policy decisions. 

The Director of Revenue Integrity I/II is responsible for developing standards and ensuring the integrity of the integrated acute care revenue charge capture. This responsibility includes all aspects of the Charge Description Master and fee schedule formulation(s), review, and maintenance to optimize compliant revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across VCHCA; policies and procedures development, modification, and maintenance. The Director of Revenue Integrity I/II will also serve as the RCM lead for supporting: payor contract negotiations, HIM and UM process improvement initiatives.

PAYROLL TITLE:  HCA Administrative Manager I/II

APPROXIMATE SALARIES: 
HCA Administrative Manager I:  $4,035.51 - $5,649.72 Biweekly
HCA Administrative Manager II:  $4,451.99 - $6,232.78 Biweekly

 Distinguishing Characteristics:

Levels in the HCA Administrative Manager classes are generally based on, but are not limited to, the agency/department's organizational complexity and size, nature and number of functions and programs, and scope of supervision including classification level or types of positions managed.

HCA Administrative Manager I is the lower level of the HCA Administrative Manager series and is distinguished by intermediate training, experience and supervision of staff. 
 
HCA Administrative Manager II is the highest level of the HCA Administrative Manager series and is distinguished by advanced training, experience and supervision of staff. Incumbents in this class are further distinguished by their ability to provide technical support and supervise multiple modalities. 

EDUCATIONAL INCENTIVE:  Some positions may be eligible for educational incentive.  This incentive may be 2.5%, 3.5%, or 5% for incumbents in eligible positions based on completion of an Associate’s, Bachelor’s, or Master’s degree that is not required for the classification.

BILINGUAL INCENTIVE:  Some positions may be eligible for bilingual incentive depending on the applicable memorandum of agreement and the needs of the department.  In order to qualify for this incentive, incumbents in eligible positions must take and pass the applicable bilingual fluency examination.

DEPARTMENT/AGENCY:  Health Care Agency - Administration

HCA Administrative Manager I/II are a Management classification and are not eligible for overtime compensation.  Incumbents in these classifications are eligible for benefits at the MB3 level.

The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-term), Intermittent, and Extra Help vacancies for this position only.  There is currently one (1) Regular position.  

TENTATIVE SCHEDULE  
OPENING DATE:  March 30, 2022                                                                        
CLOSING DATE:  Continuous and may close at any time; therefore, the schedule for the remainder of the process will depend upon when we receive a sufficient number of qualified applications to meet business needs. 
EXAMPLES OF DUTIES
Duties may include, but are not limited to the following:

Performs chart audits and provides feedback/recommendation(s) based on finding(s) to ensure accuracy of supporting documentation for captured charges;
Identifies charge capture opportunities based on supporting documentation and provides feedback/recommendation(s) and/or escalates to appropriate staff/department;
Confers with other managers on policy matters and work problems; interprets policies and procedures and explains their application within the context of the assigned program field;
Develops a charge/audit/capture/reconciliation process and providing frequent provider and staff education;
Designs operational systems and ensures conformance in daily operation; designs tools and implements methods to monitor program performance;
Develops and maintains processes and controls in compliance with regulatory requirements; analyzes new legislation and regulatory changes to determine impact to the organization; advises managers and executives accordingly and devises strategies for coping and complying with changes;
Conducts studies of operating issues, automation systems, procedures, work assignments, and forms and recommends changes to increase the efficiency and effectiveness of operations;
Identifies and develops, and prepares appropriate reports for various levels of management, implementing/integrating performance indicators and benchmarks; compiles and analyzes narrative financial information and statistical data to improve operations, identify program needs and/or change service delivery methods;
Acts as liaison to state and federal agencies and client organizations/departments regarding charging and coding operations and policies;
Represents the County in audits, as needed, hearings, and various inter-governmental task forces/committees;
Coordinates annual and ad hoc system-wide price changes, as well as required regulatory reporting (i.e., BOS, OSHPD, Internal Audit, Payer Charge inquiries);
Ensures compliance with payors, grantors, and programs, such as the Self Pay Discount Program and Health Resources Services Administration (HRSA) program rules and compliance;
Monitors critical report(s) to ensure Accounts Receivable (AR) report is within Agency standard(s);
Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, fraud alerts, OIG advisory opinions and other relevant publications. Communicates changes to impacted leaders and provides education on such changes;
Provides a structured documentation review and charge validation program coupled with provider and staff education;
Provides compliance expertise; Participates in compliance related activities, denials root cause, and process improvements; 
Ensures timeliness of claims clearing edits for billing and follow-up staff;
Optimizes appropriate and compliant reimbursement;
Provides updates and program changes affecting charges/coding to relevant staff;
Provides oversight of and responses to governmental audits such as RAC, MIC, and Third-Party Payor audits; or internal audits;
Prepares, reviews and updates training manuals on charge capture and revenue recognition in concert with HCA’s revenue cycle leadership;
Reviews billing procedures, ensuring efforts are aligned with Revenue Cycle leadership on more effective methods to improve integrity and speed of claim release to various payers;
Provides oversight to and evaluation of Hospital, Behavioral Health, and Ambulatory Care Accounts Receivable staff, processes, and policies as they relate to charge integrity and coding in conjunction with clinic and revenue cycle management;
Works closely with finance and revenue cycle leadership to achieve fiscal and operational objectives related to gross revenue budgets, strategic initiatives, decision support needs, and a variety of audits;
Leads performance improvement efforts related to charge capture and billing integrity workflows, including but not limited to timely and accurate capture of charges, coding, charge posting lag days, denials, and clean claim rates;
Participates in staff meetings and provides necessary updates and training to various staff; may supervise and assist in the planning and operation of in-service training programs; and 
Performs other duties as required.

TYPICAL QUALIFICATIONS
These are entrance requirements to the examination process and assure neither continuance in the process nor placement on an eligible list.

EDUCATION, TRAINING, and EXPERIENCE:
 
Any combination of education and experience which would demonstrate possession of the required knowledge, skills, and abilities. An example of a qualifying education and experience is:

HCA Administrative Manager I:
Bachelor's degree in Health Care, Business, Public Administration, or related field, AND, 
Three (3) years of recent and progressively responsible experience in administration, finance or accounting, which has at least two (2) years supervising professional-level staff.
HCA Administrative Manager II:
Bachelor's degree in Health Care, Business, Public Administration, or related field, AND,
Five (5) to Seven (7) years of recent and progressively responsible work experience in a highly complex healthcare Revenue Cycle environment in a medical system comparable to or at Ventura County Medical Center and clinics, which includes at least three (3) years supervising professional-level staff.

Substitution:
Up to four (4) years of additional related experience may be substituted for the bachelor’s degree.

NECESSARY SPECIAL REQUIREMENTS:
Work experience leading critical, interdisciplinary projects
Must possess and maintain a valid California driver's license
Experience in data mining and data analytics in a healthcare setting
Experience working with Cerner, including library builds, workflow, and Charge Master (CDM) management
 
HIGHLY DESIRABLE:
5 years of recent work experience in a Cerner environment 
5 years of work experience as either a Certified Coder or Registered Nurse
Recent work experience managing multiple RCM departments serving a complex, acute care provider organization
Master’s degree in Business, Public, or Health Care Administration or in a related field 
Possession of certification from the Health Care Finance Management Association (HFMA)
DESIRED: 
A Master's degree in Business, Public, or Health Care Administration or in a related field.
Certification from the Health Care Finance Management Association (HFMA)
Experience working with Cerner
Experience as a Certified Coder or a Registered Nurse 
Experience managing multiple Revenue Cycle Management departments serving a complex, acute care provider organization
OTHER REQUIREMENTS:
This position may be subject to State Health Officer Orders regarding vaccine verification and/or testing. These requirements are a condition of employment. Depending on assignment and work location(s), successful candidates for this position will be required to submit proof of vaccination and/or booster against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process.

Knowledge, Skills, and Abilities:

Thorough knowledge of: generally accepted accounting principles, practices, and standards; financial management standards and techniques; the application of automated systems for patient accounting reporting; principles of cost/benefit analysis; fiscal monitoring and control mechanisms; rules and regulations that apply to government accounting practices, procedures, and standards; fiscal practices and requirements related to health care, hospital, clinic, and other similar programs; theories, principles, and regulatory requirements related to the revenue cycle encompassing patient business services (admitting; business office practices and methods; patient chart systems and forms; hospital, clinic, and professional fee charging and coding, billing, and collection); Centers for Medicare & Medicaid Services (CMS) regulations; Medi-Cal and other laws and regulations common to hospital, public health, and behavioral health programs operation, administration, and services in California; principles and practices of program planning and evaluation; policy and procedure development; project management; budgeting methods and techniques; principles and practices of supervision, management, and public administration; conflict resolution and negotiation techniques; and laws and government regulations related to patient/client accounts, legislative/regulatory analysis, and community liaison practices; medical reimbursement programs and complexity of payment systems; Current Procedural Terminology Codes (CPT) codes, practice management systems and electronic health records systems, preferably Cerner; International Classification for Diseases (ICD)-10 codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal; Medi-Cal Provider Manuals;  and Health Resources Services Administration (HRSA) program rules and requirements  as they relate to Federally Qualified Health Clinics (FQHC).
 
 Comprehensive ability to:
 interpret certification and compliance standards; interpret and communicate health care and hospital policies, resources, and services to staff and the public; evaluate and analyze the potential impact of proposed policies and programs on service areas and clients; coordinate, organize, and implement programs and services offered at different geographic locations; collect and analyze data to identify needs; evaluate program effectiveness; develop, implement, and interpret operational procedures; identify and analyze administrative problems and implement operational changes; prepare a variety of reports and other correspondence; understand program objectives in relation to agency/departmental goals and procedures; recognize the role of assigned activities in relation to the agency/department's overall mission goals and objectives; instruct, train, supervise, and evaluate professional and non-professional personnel; make decisions and independent judgments; determine the appropriate course of action in emergency or stressful situations;
and maintain effective working relationships with staff, physicians, providers, and the public; communicate effectively, both orally and in writing.


Supplemental Information:

Work is primarily performed in an office environment, but incumbent may be required to travel to various sites.  
RECRUITMENT PROCESS
FINAL FILING DATE: This is a continuous recruitment and may close at any time; therefore, apply as soon as possible if you are interested in it.  Your application must be received by County of Ventura Human Resources no later than 5:00 p.m. on the closing date.

To apply on-line, please refer to our web site at www.ventura.org/jobs.  If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura, CA 93009.

NOTE TO APPLICANTS:  It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications.  A resume and/or other related documents may be attached to supplement the information in your application and supplemental questionnaire; however, it/they may not be submitted in lieu of the application.

 NOTE: If presently permanently employed in another "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible.  If interested, please click here for additional information.

 SUPPLEMENTAL QUESTIONNAIRE – qualifying:  All applicants are required to complete and submit the questionnaire for this examination AT THE TIME OF FILING.  The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position.  Failure to complete and submit the questionnaire will result in the application being removed from consideration.

APPLICATION EVALUATION – qualifying: All applications will be reviewed to determine whether or not the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the screening and selection process.

TRAINING & EXPERIENCE EVALUATION:
 A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.
 
 ORAL EXAMINATION - 100%: A job-related oral examination will be conducted to evaluate and compare participating examinees' knowledge, skills, and abilities in relation to those factors which job analysis has determined to be essential for successful performance of the job. Examinees must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.
 
 NOTE: The selection process will likely consist of an Oral Exam, which may be preceded or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence.  Responses such as "See Resume" or "Refer to Resume" are not acceptable and may disqualify an applicant from further evaluation.  

If there are three (3) or fewer qualified applicants, a T&E or an Oral Examination will not be conducted. Instead, a score of seventy percent (70%) will be assigned to each application, and each applicant will be placed on the eligible list.  

Candidates successfully completing the examination process may be placed on an eligible list for a period of one (1) year.

BACKGROUND INVESTIGATION:  A thorough pre-employment, post offer background investigation which may include inquiry into past employment, education, criminal background information, and driving record may be required for this position.

For further information about this recruitment, please contact Tamara Madueno by e-mail at [email protected] or by telephone at (805) 677-5313.