Director of Charge Description & Clinical Auditing - Patient Accounting & Billing Unit (Finance)
The County of Riverside's Patient Accounting and Billing Unit at Riverside University Health System (RUHS) Mission Grove location is seeking a Director of Charge Description & Clinical Auditing to join our team in Riverside.
The Director of Charge Description & Clinical Auditing will be responsible for managing and optimizing the standard Charge Description Master (CDM) to ensure it is accurate and compliant with coding rules and billing regulations. This position will lead the department's efforts in reviewing and researching charge-related data to maintain compliance and accuracy within the system's CDM. The Director will ensure that CDM maintenance requests are processed and completed efficiently, accurately, and in a timely manner.
Additionally, the Director will collaborate with RUHS stakeholders to identify charge-related opportunities, evaluate current procedures, and assess internal controls to ensure charge master code compliance, charge accuracy, and improved charge capture. The role also includes maintaining oversight of the department's documentation of policies and procedures, ensuring compliant billing practices, and educating department staff and other stakeholders on CDM maintenance processes and compliance.
Desired Qualifications:
- A Master's degree in Healthcare Administration, Business, or a related field
- At least one (1) year of hands-on experience with Charge Description Master (CDM) management, including auditing, adding, deleting, updating, cash pricing, and OSHPD reporting.
- Proven experience in clinical audits, including auditing billing charges and handling clinical payer appeals in a hospital environment.
- C linical experience as an LVN or RN is preferred
- Professional-level experience with EPIC
- Advanced proficiency with Microsoft Excel, including data analysis and report generation.
- Bilingual skills in English and Spanish preferred.
Work Schedule:
9/80 Friday - Day Shift
This position is strictly on-site, with no remote work options. The first 30 days of training will follow a 5/8 schedule.
Meet the Team!
Riverside University Health System (RUHS)
The classification for this position is Director of Patient Access/Patient Business Services; however, the working title is Director of Charge Description & Clinical Auditing. This is a continuous posting and will remain up until the position is filled. Applications will be reviewed, and competitive candidates will be referred for interviews in the order in which they are received.
This class has been designated At-Will by the Board of Supervisors, in accordance with the provisions provided under Article 6, Section 601E (8) of the County Management Resolution and serves at the pleasure of the Assistant County Executive Officer-Health System.
This class has been deemed eligible for the Performance Recognition Plan as set forth under Article 3, Section 311(C) of the County Management Resolution. Program eligibility requires employees to be in a leadership position, manage other employees or programs, and have significant influence on the achievement of organizational objectives.
- Responsible for oversight and management of CDM team.
- Responsible for developing and maintaining the Charge Master standard.
- Ensures that the RUHS system standard Charge Master meets federal, state regulatory requirements and guidelines and adheres to RUHS policies.
- Works with departments to ensure that the Charge Master accurately reflects the services provided by the clinical departments.
- Responsible for periodic reviews of all hospital charges to ensure that all charges are in compliance with RUHS system standard Charge Master.
- Responsible for routinely communicating the status of CDM integrity and accuracy to key stakeholders; notifies stakeholders as appropriate when issues arise.
- Provides reports and other documents as required to measure compliance to the standardized CDM.
- Develop Policies and Procedures for maintaining the RUHS standard CDM incorporating the RUHS CDM Guiding Principles and Charge Policies.
- Evaluates the efficiency or adequacy of Charge Master related processes and leads the development of new procedures as appropriate.
- Builds and maintains effective working relationships with other departments (Epic IS, HIM/Coding, Compliance, Patient Access, Clinical depts. etc.)
- Responsible for implementing routine, standardized reporting to provide stakeholders with commonly requested CDM extracts, Revenue and Usage, etc.
- Serves as Charge master expert for executives and Revenue Cycle pillar leaders; and provides support to CDM team, Revenue Cycle and hospital stakeholders.
- Consults with internal and external customers on the development and implementation of projects and process improvement.
- Maintains communication with all stakeholders to ensure efficient operations and successful implementations; including management of customer satisfaction and expectations.
Experience: Three years of supervisory experience, which included responsibility for patient access or revenue cycle activities in a hospital or healthcare organization.For questions regarding this recruitment please contact the recruiter, Jill Eastman, at JEastman@rivco.org
