Position Title

Director, Revenue Assurance and Auditing

Days - Full Time

Westwood Administration - East

Position Summary / Career Interest:

The Director, Revenue Assurance and Auditing is responsible for the effective oversight of the University of Kansas Health System's regulatory compliance across billing, coding, and documentation. The Director manages the System's revenue assurance management functions, including Hospital Billing (HB), Ambulatory and Provider Billing (PB) Assurance/Compliance activities. This position works in close partnership with the Senior Director, Revenue Assurance, Audit, and Advisory Services and the Chief Compliance and Internal Audit Officer to align Revenue Assurance strategy with the overall mission and vision of the University of Kansas Health System. This role is responsible for the enterprise billing compliance functions, including Hospital Billing Compliance (design and supervision of internal audits, Epic build reviews, HB/PB collaborative audits, investigations of alleged non-compliance, and results reporting). Responsibility includes Ambulatory and Provider Billing Compliance (risk-based audits and targeted audits), enterprise Billing Assurance (monitoring, analytics, education and regulatory/payor research), Consulting (new service line/departments builds, Epic rule validations, HITS projects, Revenue Cycle projects). This is a high-profile group tasked with improving overall revenue results and risk mitigation by taking a global view of billing assurance oversight and practices, adhering to audit plans to mitigate legal and regulatory risks taking into account interdependencies from the provision of patient care to final bill generation.

Responsibilities and Essential Job Functions

Identifies and articulates the strategic direction for the Revenue Assurance and Audit team and collaborates with direct reports to drive alignment.
Responsible for support, leadership and guidance to Revenue Assurance and Audit team.
Responsible for hiring, disciplinary actions and performance evaluations for staff.
Responsible for building out succession plan for the Revenue Assurance and Audit team in collaboration with Senior Director.
Tracks relevant changes in performance, market trends, health care delivery systems, legislative and industry initiatives impacting execution of team goals or informing course correction of goals.
Collaborates with peer leadership and the Enterprise Compliance and Audit Services as well as Revenue Cycle and Managed Care Contracting leaders to design the strategic plan and KPIs for the Revenue Assurance and Audit organization.
Maximizes existing talent by providing counsel, leadership, guidance, and direction and assisting in the development of an organizational culture appropriate to support the University of Kansas Health System mission.
Strategically partner with clinical teams and stakeholders beyond revenue assurance and auditing to cultivate key performance behaviors and operational improvements to mitigate risk to revenue.
Educates hospital and ambulatory departments and physicians regarding documentation and billing requirements, charging methodology, and various other areas of compliance.
Direct internal audit programs focused on coding, billing and documentation accuracy.
Leads the revenue assurance audit team, promoting an efficient and results orientated auditing program.
Develops risk-based annual audit and monitoring plan that includes areas of risk.
Drives financial planning, monitoring and execution to support a cost-effective Revenue Assurance and Audit team.
Participates in the development of the operational budget for the Revenue Assurance and Audit function.
Quantitatively and qualitatively analyzes team performance using metrics related to team leadership and Revenue Assurance and Audit operational success; translates performance analyses into performance improvement initiatives.
Defines and holds Revenue Assurance and Audit team accountable to Key Performance Indicators.
Monitors the departments’ success by evaluating key financial, budgetary, and other metrics related to Revenue Billing Assurance and Audit team effectiveness.
Oversees efforts to promote timely compliance with regulatory agencies.
Provides direction and oversight across TUKHS’s billing assurance auditing and monitoring methodology and workflows.
Reviews and approves revenue assurance, billing compliance, audit and monitoring attributes for new methodologies, innovative tools and deliverables and responsible for developing and maintaining a risk tolerance for noncompliance.
Tracks revenue issues and trends for auditing and root cause remediation for errors and reporting purposes.
Identifies services that are at risk and trends that may show are not being charged compliantly.
Review charges and claims to ensure accurate, compliant billing as it relates claims logic, CPT, HCPCS, revenue codes, etc.
Meets or exceeds standards of compliance for all accreditation and regulatory bodies, commissions, etc. in relation to Revenue Assurance and Audit team functions.
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

Bachelors Degree in Business Administration/Management or related field OR
Bachelor of Science in Accounting OR
Bachelors Degree in Health Care Administration OR
8 or more years related experience in healthcare billing assurance operations AND
6 or more years of integrated experience in billing assurance multi-disciplinary projects, including auditing of clinical and financial records
5 or more years experience in a leadership role with professional level employees

Preferred Education and Experience

Bachelors Degree in Health Information Management
Masters Business Administration OR
Master's Degree in Health Care Administration
10 or more years experience in healthcare billing assurance operations
7 or more years of integrated experience in billing assurance multi-disciplinary projects, including auditing of clinical and financial records
6 or more years of experience in a leadership role with professional level employees

Preferred Licensure and Certification

Certified Public Accountant (CPA) - State Board of Accountancy

Knowledge Requirements

Demonstrated competency and senior leadership experience in a large, complex organization with multiple locations.
Excellent leadership and organizational management skills – including written and oral communication, relationship management, customer service, and organization.
Strong knowledge of: * Healthcare audit functions, including ambulatory and provider charging and billing, hospital charging and billing, data analysis, Epic report function * Healthcare Rev. Cycle functions, including registration, coding and documentation standards, billing / collection, etc. * CMS regulations, medical terminology and the various data elements associated with the UB-04 and CMS-1500 claim form * Medical records, hospital bills, and service item master * Local, state and federal regulatory requirements as well as ICD-10, HCPCS, CPT, and Revenue Codes * Epic clinical and charging applications and CDM and chargemaster workflow platforms
Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development.
Ability to make multiplex decisions for the betterment of the organization.
Create and manage respectful and impactful relationships with internal and external stakeholders.
Experience and passion towards mentoring team members and establishing succession plans for departments, as well as the ability to execute those plans.

Time Type:

Full time

Job Requisition ID:

R-48354

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

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