As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Director, Revenue Cycle Compliance contributes to Conifer Healthâs (Conifer) purpose by providing both strategic and day-to-day leadership to the compliance program designed to ensure Conifer fully complies with its Code of Conduct and all applicable laws and regulations. The Compliance Director supports his/her respective area(s) of Coniferâs Ethics and Compliance program which may include, but not be limited to: Revenue Cycle Compliance, Monitoring and Oversight, Regulatory Change Management, Vendor Oversight, Investigations/Client Engagement, and Compliance Operations.
The Director, Revenue Cycle Compliance, implements, and oversees the compliance program; including (1) maintaining and expanding visibility of the compliance program at all levels within the organization (2) ensuring there is an effective compliance program and oversight in place to remain compliant with all local, state, and federal healthcare rules, regulations and adimistrative requirements and (3) when appropriate, leading and developing team members to support programmatic efforts.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Functions as a revenue cycle compliance subject-matter expert for responding to revenue cycle-related questions and providng consultative guidance for revenue-cycle related investigations.
Participates in the development and implementation of the Revenue Cycle Compliance portion of Coniferâs Annual Ethics and Compliance work plan.
Reviews and assesses risk assessment findings
Oversees and/or performs Work Plan-related reviews and projects by defining review/projects scopes and processes; gathering and analyzing data; and documenting findings.
Drafts meaningful audit reports.
Collaborates with Operations to develop and implement effective corrective action plans.
Routinely uses data analytics to identify and address potential compliance risks.
Monitors, analyzes, and interprets regulatory changes related to revenue cycle. Assists in overseeing the efforts to respond to new or changing regulations, including but not limited to communicating regulations to leadership and affected departments, and participating in implementation work teams.
Collaborates with key leadership, team members, contractors and other stakeholders throughout Conifer to promote a culture of compliance.
Participates in strategic planning efforts related to the revenue cycle compliance program.
Identifies and implements revenue cycle compliance-related education designed to reduce compliance risk for both Conifer and the clients we serve.
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports: Manager, Senior Specialist, and/or Specialist as applicable
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to work independently with little supervision and seek guidance as needed to clarify assignments or request for information.
Excellent communication, customer service and time-management skills
Strong team-building and development skills
Possess basic business skills, an understanding of general compliance operations and department goals in the healthcare environment.
Proficient with various desktop applications such as Microsoft Excel, Word, PowerPoint and/or Access.
Intermediate knowledge of relational database management systems
Must be a team player - Always willing to help in whatever way possible and go the extra mile to get the job done.
Intuitive and skilled at problem solving in anticipation of team member and client request
Have the ability to make logical correlations between data points to determine if analysis is accurate
Detail oriented, meticulous and accurate in completing tasks on time
Revenue Cycle Compliance Director Specifics:
Monitors, analyzes, interprets, and communicates regulatory changes related to coding, billing, and collections. Leads and oversees efforts to respond to new or changing regulations, including but not limited to communicating regulations to leadership and affected departments, assembling and chairing work teams.
Ensures compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS), as well as other federal and state laws and regulations that govern matters related to hospital and physician revenue cycle.
Oversees the follow-up to ensure timely repayment is made for all identified overpayments received from government agencies and patient.
Oversees the development and implementation of compliance policies and procedures related to the organizationâs hospital and physician revenue cycle.
Reduces organization risk by identifying risks related to hospital and physician revenue cycle and manage annual work plan to address identified risks.
Contribute to the annual compliance monitoring plan and oversee the components related to hospital and physican revenue cycle activities.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Masters Degree in Business, Information Systems, Health Care Administration; Juris Doctorate or related field or equivalent years of related Manager experience required.
Minimum of five (5) years experience in related area with two of theseyears being healthcare management or healthcare compliance.
Variety of billing and/or coding certifications will be considered and are preferred
Certified Healthcare Compliance (CHC) is preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to Travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Up to 20%
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.