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Posted: Monday, January 8, 2018 2:28 AM

Manages Revenue Integrity Charge Edit daily operations including National Council on Compensation Insurance (NCCI) edits, modifier application and charge edit resolution. Provides supervisory coaching and support; issue identification, assessment, and resolution; and technical support in order to achieve desired outcomes and compliance with Sutter Health policies/procedures and standards. Collaborates with Revenue Integrity Team, Charge Capture Team and all Revenue Cycle Teams to provide charge capture guidance to our affiliate service line departments. Supports internal controls, monitors employee performance, and performs staff development, retention and selection.

Provides supervisory leadership and direction to the assigned Revenue Integrity Charge Edit Team. Manages team workload, resources and compliance with Service Level Agreements to ensure activities are executed accurately and efficiently. Ensures adherence to established Sutter policies, government regulations and payer requirements. As a team lead in a shared services environment, assists in establishing and maintaining strong, collaborative relationships with all internal and external customers to identify additional ways to be of service and ensure customer satisfaction.

Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Sutter Shared Services (S3) vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. Participates in programs and in using tools in support of building a high performance culture via the standard Sutter Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.).

This position is part of the Revenue Integrity (RI) Team at Shared Services. This team is responsible for ensuring that there is a standard and consistent Charge Description Master (CDM) available for our Acute Care facilities and that this CDM is current and accurate according to all regulatory and payer guidelines. RI is responsible for ensuring that there are standardized charging procedures in place so that accurate, compliant and consistent charge capture is possible and for assisting the Charge Capture team in the development of training on these procedures. RI monitors and reviews charge detail to ensure compliance with these standardized charging procedures. This includes resolving and trending charge related claim edits as well as performing chart to charge audits in defined intervals and reviewing data for potential missed revenue in order to maximize appropriate reimbursement. RI participates in and supports development related to new services to ensure that the infrastructure is in place to capture the appropriate revenue.


* Bachelor's degree in Business or Healthcare Administration Or equivalent education/experience required.

* Master's degree preferred.


* Demonstrated leadership experience and a proven track record in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims management in a facility of significant size and complexity, hospital business operations, information systems, and patient accounting applications, as typically acquired in 3-6 years of acute hospital CBO management positions required.

* Demonstrated experience and a proven track record in Coding in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 2-4 years of experience performing acute care inpatient, outpatient, and/or emergency department coding required.

* Experience developing Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claim standards, processes, policies, procedures and service level agreements required

* Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships desired.

* Experience participating in planning new or expanded services and managing projects desired.

Skills and Knowledge:

* Deep familiarity with general hospital management principles, practices, and procedures.

* In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims and how they interrelate.

* In-depth knowledge of advanced principles, methods, and techniques related to compliant healthcare coding, billing/collections.

* A comprehensive knowledge of Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims management functions in acute and non-acute settings.

* Knowledge of medical terminology, disease processes, patient health record content and the medical record coding process.

* Knowledge of computer based encoder systems and accurate data entry skills.

* Basic knowledge of anatomy, physiology and pharmacology.

* Familiarity with the components of a charge description master and general charge capture principles.

* General knowledge of Revenue Cycle applications, including Electronic Health Record systems.

* General knowledge/awareness of all areas related to Coding and how they interrelate.

* Knowledge of principles, methods, and techniques related to compliant healthcare coding, billing/collections.

* Familiarity with Coding management functions in acute and non-acute settings.

* Knowledge of Patient Management information system applications, preferably EPIC.

* Familiarity with work standards and productivity measures, quality control mechanisms, and workload distribution.

* Knowledge of technological advancements, labor savings procedures/ processes/ equipment and other state-of-the art department-specific systems.

* Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in a Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims function.

* Ability to serve as a reference and coach others on key Payer-specific (Medicare, MediCal, Medicaid, and/or Private) coding and claim processes, policies, and procedures.

* Aptitude to conceptualize, plan, and implement stated goals and objectives.

* Ability to independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects while leading a high volume, high accuracy work team composed of individuals having diverse personalities and work styles.

* Ability to communicate and work with patients, physicians, associates, Sutter Health leadership, multiple direct patient care providers and others in order to expedite the Revenue Integrity Charge Edit process. Strong communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers.

* Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership.

* Ability to comply with Sutter Health policies and procedures.

* Excellent ability to identify, prioritize, resolve and / or escalate complex problems promptly.

* Excellent ability to establish, develop and manage customer relationships.

* Ability to learn new applications/software systems effectively and efficiently.

* Demonstrated leadership skills and the ability to provide supervision, direction, and constructive feedback to team members to support continuous improvement.

* Ability to effectively detect, surface and resolve conflicts among individuals and/or work groups.

* Ability to communicate ideas both verbally and in writing to influence others using on-on-one contact and group discussions.

* Ability to recognize the appropriate style, level of detail, and message for the audience.

* Ability to positively influence others in a desired direction to achieve identified outcomes.

* Ability to develop effective working relationships/ networks within and outside the organization.

* Skills using spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite.

* Well-developed process design, implementation, and improvement skills.


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• Location: Roseville, Sacramento

• Post ID: 21333057 sacramento is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2018