System Director, Revenue Integrity, Remote

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Oversees the revenue integrity functions that support accurate charging and billing in compliance with state and federal regulations across all Adventist Health system wholly owned hospitals, entities, and professional services. Oversee technical billing integration plus Clinical and Organizational project change management initiatives. Provides technical guidance on complex and cross IT application architecture implementations, updates and maintenance. Develops strategy and provides technical expertise during all phases of the application development life cycle. Develops and executes system-wide standardization and long-term strategies to meet expanding and changing needs, in collaboration with operational leadership; provides expert advice on charging/reimbursement aspects of growth initiatives; sets hospital and professional prices; develops and implements policies for the operations; leverages automation for the technical CDM build within Cerner; assures compliance; manages staff, and directs department communication and education of charge capture related matters.

Job Requirements:

Education and Work Experience:

• Bachelor's Degree in business administration, finance, accounting, health care administration, public health, or a related discipline or equivalent combination of education/experience: Required
• Master's Degree: Required
• Seven years' healthcare revenue cycle experience: Preferred
• Seven years' application/technical work experience with the Cerner or other EHR modules (Acute, Ambulatory, Ancillary, Emergency Department, Laboratory, Patient Accounting, Maternity, Radiology/Pharmacy, Revenue Cycle, Surgery / Anesthesia): Preferred
• Five years' leadership experience: Preferred

Essential Functions:

• Oversees the Adventist Health charge capture and late charge management processes. Manages charge coordinator team members responsible for account reviews/audits, department charging procedures, and education for peripheral departments as necessary. Directs and oversees technical integration and maintenance of our revenue cycle and clinical systems to include patient financial services and finance. Works in conjunction with Cerner Oracle client accountable leadership, upgrade center, and application management support (AMS) to manage database administration and change control functions. Monitors vendor (e.g., Cerner IT) service level agreements (SLAs), escalating as needed to meet contractual requirements. Establishes and maintains internal service level agreements (SLAs).
• Provides recommendations on industry and application integration trends in analyzing and planning current and future revenue integrity IT needs. Coordinates with revenue cycle governance and legal establishing and/or facilitating IT architectural standards and frameworks to ensure that standards are consistently applied. Provides technical guidance on complex and cross IT application architecture challenges. Plans an active role as a technical expert during all phases of the application development life cycle. Participates in architecture brainstorming and design discussions with team members. Collaborates in enterprise and departmental process design activities with systems implementation activities.
• Coordinates activities of the technical and functional teams that include resolve system design issues. Identifies technical and infrastructure requirements, develops testing, trains and converts plans. Develops and/or contributes to multi-disciplinary workflow documentation. Coordinates appropriate resources in the development of foreign system (e.g, Pathnet, Pharmnet, Radnet, McKesson, Vitalware) and instrument interface specifications. Works closely with vendors, clinical leaders, revenue cycle, finance and/or project manager on all aspects of the projects. Assists in development of detailed project plans in regard to the build tasks necessary to complete the projects. Determines the order and timing in which tasks must be completed. Develops and maintains environmental/domain planning according to project timelines.
• Assists project teams in planning and coordination of testing and training plans. Identifies the resources needed and the role of each member of the project team. Monitors projects continually in terms of the timeline and overall quality. Facilitates communication between all parties involved in an implementation to ensure that the teams are effectively working together. Manages oversight of all revenue integrity positions across the markets. Provides leadership/guidance and drives scope of work, process, and monitoring via key performance indicators (KPIs).
• Plays a critical role interfacing with departments that impact revenue, including coding, clinical documentation integrity (CDI), revenue recovery unit (RRU), billing, collections, denials, and clinical departments where necessary. Creates detailed and complex financial models, designing and implementing a comprehensive denials and underpayment system involving audit/appeal workflows. Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Leads and oversees revenue integrity departments that currently sit in the markets, establishes consistent scope and processes across the system, and monitors key performance indicators.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.