ICD 10 / RESEARCH BILLING COMPLIANCE ADVISOR
Dignity Health - San Francisco, CA

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Job Summary:
The Research Billing Compliance Program Advisor is responsible for assisting the Dignity Health Human Research Protections Office (HRPO) and Clinical Research Thought Leadership Group (TLG) in analyzing, benchmarking, designing, recommending, and implementing clinical research billing (CRB) processes for Dignity Health Research Enterprise operations that achieve overall billing compliance strategies and associated objectives for the enterprise wide implementation of ICD10. These processes shall incorporate best practices and meet all regulatory requirements to assure appropriate coding and billing of clinical research procedures and services. The position requires an in depth understanding of research financial and patient billing practices as well as the patient revenue cycle. It will involve working with the full range of Revenue Cycle functions including Admitting, Coding, HIM, and Billing, as well as Research Program Managers, coordinators, and other research staff as stakeholders and process owners.

This position is a limited term position funded through December 2014.

Accountabilities:
  • Develops materials (strategy guidelines, training materials, policies, procedures, process flows), and implementation plans as needed by the Research TLG.
  • Actively engages with the Research TLG and work stream leads to provide knowledge and guidance to implement best practices.
  • Demonstrates understanding of transformation projects involving research team workflow, revenue cycle workflow, and improvement of financial review processes and documentation.
  • Effectively illustrates how proposed changes will affect the research community and the Dignity Health enterprise, and how to introduce change in a manner that promotes investigator, research administration and compliance program collaboration.
  • Attends weekly meetings consistently, in order to maintain current understanding of the accomplishments and challenges the teams are facing within their day-to-day activities.
  • Effectively interacts with leadership, research program managers, other corporate, regional, and local facility managers and staff regarding the Research TLG initiatives & CRB requirements.
  • Proactively participates in the development of a plan for the Dignity Health research billing compliance program expansion based on industry best practices, including identification of high impact areas, roles and responsibilities within each as it applies to CRB.
  • Proactively participates in developing a research financial review & billing compliance model that integrates with other pertinent healthcare initiatives across all research sites within the organization.
  • Provides the educational resources needed to each area impacted across the Dignity Health sites, & travels to each as directed to assist in implementation of the developed initiatives.
Minimum Required:
  • 3 years experience in either a clinical research financial role (i.e., budget analyst, coverage analyst, regulatory coordinator, or research financial manager role) or a patient revenue cycle role at an organization involved in research (i.e., patient financial services or revenue cycle analyst or manager).
  • Demonstrated knowledge and expertise in process improvement and project management..
  • In-depth understanding of general coding and billing policies, procedures and process flows for research, including the NCD on Clinical Trials, coding and modifiers needed, and other Medicare requirements for research claims.
  • A working knowledge of the financial management of clinical trials, including exposure to trial budget development, Medicare coverage analysis, proper identification, registration, and billing for research patients, and auditing of the clinical trials patient billing process.
  • D emonstrated ability to achieve desired results within projected timeframes and cost.
  • Experience advising Management in a project related setting and working with stakeholders at all levels of an organization.
Preferred/Desired:
  • Prior direct responsibility in the areas of research budgeting, coverage analysis, and inpatient and outpatient billing (i.e., revenue cycle), and clinical trials compliance or billing auditing.
  • Experience serving in a lead or key role on projects to analyze and design policies, procedures, and processes for clinical trial patient billing.
  • Knowledge of charge description masters(CDM) and facility and professional fee components and associated billing processes.
  • Experience in either medical coding or medical billing within a hospital setting I would see this a more of a min. requirement.
  • Direct experience in medical coding and billing of research related claims.
  • Knowledge of ICD-10 coding.
  • Knowledge and experience working with inpatient and outpatient registration and billing systems (particularly Cerner, Meditech, Allscripts)
Membership and experience through National Commission of Certifying Agencies either with professional coding associations AAPC or AHIMA Education

Education:
Minimum Required:
  • Bachelor’s degree in healthcare related field
Preferred/Desired:
  • Compliance Certification through HCCA as CHC or CHRC
  • Coding or Billing Certification through AAPC or AHIMA
  • Research Clinical Coordinator Certification (ACRP or SOCRA)
  • Masters’ Degree preferred in healthcare related field.
Required Technical Competencies:
  • Planning, Organizing, and Managing Individual Projects
  • Medicare Regulations
  • Revenue Cycle Process
  • Medical Coding
  • Process Design
  • Process Implementation
  • Project Management
  • Financial Budgeting and Forecasting
  • Clinical Research Patient Billing, Auditing, and Monitoring
Travel:
Travel to Dignity Health corporate offices in Pasadena, Phoenix, Sacramento, and San Francisco as needed

~cb~ 8/23/2013

About Dignity Health

Dignity Health, headquartered in San Francisco, Calif., provides integrated, patient and family centered care. It is the fifth largest health system in the country with 10,000 physicians and 55,000 employees across Arizona, California, and Nevada. Through its network of more than 150 ancillary care sites and 40 acute care hospitals, Dignity Health is committed to delivering compassionate, high-quality, affordable health care services with special attention to the poor and underserved. In 2011, Dignity Health provided $1.4 billion in charity care, community benefit and unreimbursed patient care. For more information, please visit our website at www.dignityhealth.org. Dignity Health is also on Facebook and Twitter.

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