Director, Revenue Integrity

Why join Scripps Health?

AWARD-WINNING WORKPLACE:

         #5 in Fortune Best Workplaces in Health Care 2023

         #78 in 2023 PEOPLE Companies that Care

         #95 in Fortune 100 Best Companies to Work for 2023

         Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024

         Nearly a quarter of our employees have been with Scripps Health for over 10 years.

Primary job responsibilities to include:

• The Director of Revenue Integrity is responsible for oversight and leadership of the activities and functions for system hospital and professional charge master maintenance and charge capture optimization. 
• Participates in establishing and ensures achievement of the organization's strategic objective and leads strategic planning for assigned areas.
• Provides functional expertise essential to support department directors and managers and/or executive team.
• Oversees budget for assigned areas.
• Directs standards of practice and process improvement activities.
• Oversees staffing matrices and possesses authority to hire, conduct performance evaluations, and discipline employees.
• Directs policy and procedures formation for guiding and supporting the provisions of service.

The ideal candidate:

• We are seeking a director level leader with deep expertise in both Hospital and Professional charge capture within an Electronic Medical Record platform.  To include charge optimization, charge master maintenance, reporting and monitoring  of charging integrity.
• Experience with Service Line charge optimization and has knowledge of Medicare and Payer regulations, Coding and Billing rules.
• It is preferred if you have previous experience working on the EPIC EMR platform.  

You will work closely with all departments within our Scripps Health System to ensure that there is an effective workflow in place for charge capture optimization.

This is a hybrid position that will require availability to work on-site and have flexibility to work remotely. Our corporate offices are located in San Diego, CA.

Required Education/Experience/Specialized Skills: 

• Bachelor's degree with a minimum of 5 years' experience in ChargeMaster set up and maintenance, Revenue Capture, Revenue Integrity, and in a Health system setting (e.g., acute care, ambulatory).
• Minimum of 3 years of experience in Leadership & Management role.
• Proven leadership skills in managing complex programs and motivating staff to accomplish targeted outcomes.
• Experience in designing workflow and process improvement.
• Proven expertise in regulatory requirements, payer regulations (government, health maintenance organizations and private payer) that impact charging, billing, and denial management.
• Knowledge of ICD 10 and/or CPT/HCPCS coding
• Knowledge of healthcare delivery in Hospital and Professional settings and the regulatory requirements.

• Ability to interpret and apply written regulation, guidelines, and other materials with ability to read and interpret clinical information.
• Strong analytical, assessment and problem-solving skills.
• Must have experience in researching and determining eligibility of beneficiary and regulations that apply to denial management for medical necessity.

Preferred Education/Experience/Specialized Skills/Certification: 

• Clinical certification or license (e.g., Registered Nurse, Allied health)
• Coding certification (CPC, CCS)
• Working knowledge of Charging requirements to be housed in an Electronic Medical Record platform such as EPIC.