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Director of Clinical Reimbursement

Apply now Job No: 495194
Department: Corporate Compliance Office
Local Title: Director of Clinical Reimbursement
Budget Title: Associate for University Financial Analysis
Work Type: Full Time
Location: Brooklyn, NY
Categories: Management and Professional, Administrative, Information Technology, Finance

 

Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

Bargaining Unit:

MC

Job Summary:

The Office of Compliance and Audit Services at SUNY Downstate Health Sciences University is seeking a full-time Director of Clinical Reimbursement.

This position operationally reports to the VP for Compliance and Audit Services. The Clinical Reimbursement compliance staff report directly to this position.

The Director of Clinical Reimbursement oversees the billing and coding compliance programs for both the Clinical Practice Management Plan (CPMP) Downstate University Physicians and the University Hospital at Downstate. This individual works closely with department leaders and clinical providers to identify coding, billing, and documentation workflow issues and to identify, facilitate and address educational opportunities.

Primary Responsibilities:

  1. Design and implement annual work- plan based upon an annual assessment of risk related to coding and billing compliance. This task should be performed in conjunction with the Revenue Cycle Advisor. Risk assessment should consider the following:
    1. Historical information related to internal issues that require oversight
    2. New internal concerns that have been identified- collaboration with clinical leaders, revenue cycle management, and hospital/ physician leaders is necessary
    3. Data- driven reports on outlier cases
    4. Industry hot topics
    5. CMS, OIG, OMIG areas of focus
  2. Annual work- plan must include quarterly goals that meet all Federal, State and local coding and billing requirements. It should encompass:
    1. Brief description of each audit area/ topic covered in the work- plan
    2. Outline of the audit sample selection process- including number of billing physicians, the total representative audit sample of their patient records, and approximate number of hours estimated to complete the audit
    3. Curriculum for individual and group physician education and training
    4. Curriculum for support staff education and training
  3. Develop, update and/or maintain coding and billing audit policies and procedures, guidance documents and relevant templates, reports and forms.
  4. Perform and oversee coding and billing compliance audits, utilizing standard performance metrics including score- cards, graphs and other visual tools to monitor and track improvements in audits conducted year over year.
  5. Serve as an institutional subject matter expert and authoritative compliance resource on the interpretation and implementation of coding, documentation and billing rules and regulations related to professional and hospital reimbursement. Collaborate with other departments to investigate and resolve compliance concerns related to coding and billing compliance.
  6. Proactively educate clinical and administrative personnel, including conducting formal and individual training and online based training. Routinely monitor and improve training tools.
  7. On a continuous basis, evaluate the effectiveness of internal and operational controls designed to ensure that applicable coding, billing and documentation standards are being followed. Facilitate, promote, and support the implementation of billing/ coding compliance, documentation and reporting initiatives.
  8. Maintain current knowledge of official coding and billing guidelines, regulations, national trends pertaining to CMS, HHS and State Medicaid requirements as they relate to coding and billing compliance operations. Complete continuous education training and continuously research best practices.
  9. Organize and manage the daily operations of the coding and billing team including workflow, staffing, data management and reporting. Conduct routine meetings with staff to ensure work- plan objectives and targets are being achieved. Prepare quarterly summations and end of year reports.
  10. Maintain positive, collaborative and professional relationships with providers and management at all levels, including demonstrating professional expertise and maintaining high standards of ethics and integrity at all times. 

Required Qualifications:

  • Bachelor's Degree required in healthcare related field.
  • AHIMA certification required.
  • 6+ years of experience in hospital and/or professional coding required.
  • Expert knowledge of ICD-10, CPT, HCPCS, DRGs and APCs/APGs.
  • Demonstrated understanding of complications & comorbidities and their impact on documentation and reimbursement.
  • Knowledge of legal, regulatory and local policy compliance issues related to coding, billing and documentation.
  • Experience in provider education.
  • Proficiency in root cause analysis, critical thinking, ability to effectively communicate both orally and written.
  • Excellent organizational skills and ability to work independently as well as multi-task.
  • Demonstrated proficiency in administrative tasks including report writing as well as technical proficiency with tools, software and EMR systems.

Preferred Qualifications:

  • An additional four years experience in coding/ auditing management preferred.

Work Schedule:

Monday to Friday; 9:00am to 5:00pm

Salary Grade/Rank:

MP-3

Salary Range:

Commensurate with experience and qualifications

 

COVID-19 Vaccination Requirement:

 

  An approved COVID-19 vaccination.

Executive Order:

Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation.  If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov.

Equal Employment Opportunity Statement:

SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.

Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at 718-270-3025.

 

Advertised: Eastern Standard Time
Applications close:

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