Revenue Integrity Manager I/Ii

PAYROLL TITLE: HCA Administrative Manager I/II
APPROXIMATE PAYROLL TITLES AND ANNUAL SALARIES:
HCA Administrative Manager I: $115,121.95 - $161,170.73
HCA Administrative Manager II: $127,002.87 - $177,804.00
Distinguishing Characteristics:
HCA Administrative Manager I is the lower level of the HCA Administrative Manager series and is distinguished by intermediate training, experience and supervision of staff.
HCA Administrative Manager II is the highest level of the HCA Administrative Manager series and is distinguished by advanced training, experience and supervision of staff. Incumbents in this class are further distinguished by their ability to provide technical support and supervise multiple modalities.
EDUCATIONAL/BILINGUAL INCENTIVE: Possible educational incentive of 2.5%, 3.5%, or 5% based on completion of Associate's, Bachelor's, or Master's degree. Incumbents may also be eligible for bilingual incentive depending upon operational need and certification of skill.
AGENCY/DEPARTMENT: Health Care Agency - Administration
HCA Administrative Manager I/II are Management classifications and are not eligible for overtime compensation.
The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed term), Intermittent, and Extra Help vacanciesfor this and similar positions only. There is currently one (1) Regular, full-time vacancy.
TENTATIVE SCHEDULE
RECRUITMENT OPEN: January 2, 2024
RECRUITMENT CLOSE: January 23, 2024 at 5:00 p.m.Duties may include, but are not limited to the following:

• Manages and supervises projects, assisting staff in the planning and operation of in-service training programs; conducts research on complex charging/billing issues, performs chart audits and charge reconciliation; identifies opportunities for charge capture, and analyzes financial data in adherence to regulatory guidelines; provides feedback/recommendation(s) on supporting documentation and/or escalates to appropriate staff/department;
• Uses structured and independent judgment to solve problems and achieve proficiency by developing a charge/audit/capture/reconciliation process to ensure compliant charge capture and reimbursement;
• Evaluates operating issues, automation systems, procedures, work assignments and forms to recommend and implement efficiency and effectiveness enhancements; designs and implements operational workflow systems, ensuring daily operations conform to optimized processes; and develops tools and methods for ongoing monitoring of program performance;
• Identifies, develops, and prepares appropriate reports for various levels of management, implementing and integrating performance indicators and benchmarks; compiles and analyzes narrative financial information and statistical data to improve operations, identifies program needs and/or change service delivery methods;
• Develops and maintains processes and controls in compliance with regulatory requirements; analyzes new legislation and regulatory changes to determine impact to the organization; advises managers, executives accordingly and devises strategies for complying with changes;
• Confers with other managers on policy matters and work problems; interprets policies and procedures and explains their application within the context of the assigned program field, and provides ongoing education to staff and provider;
• Acts as liaison to state and federal agencies and client organizations/departments regarding charging and coding operations and policies; represents the County in audits, hearings, and various inter-governmental task forces/committees;
• Manages ad hoc system-wide price changes (yearly) and required regulatory reporting e.g., Department of Health Care Access and Information (HCAI), Centers for Medicare & Medicaid Services (CMS), Board of Supervisors, Internal Audit, Payer Charge inquiries, etc.;
• Monitors industry requirements and regulations, staying current on changes related to acceptable documentation and billing practices by reviewing sources such as the Federal Register, fraud alerts, Office of Inspector General (OIG) advisory opinions, and other pertinent publications. Communicates these changes to key decision-makers and provides education to relevant personnel to ensure a comprehensive understanding of the implications of regulatory changes;
• Works closely with finance and revenue cycle leaders to achieve fiscal and operational objectives related to gross revenue budgets, strategic initiatives, decision support needs, and a variety of audits;
• May supervise, train and mentor staff; and
• Performs other duties as required.

These are entrance requirements to the examination process and assure neither continuance in the process nor placement on an eligible list.
EDUCATION, TRAINING, and EXPERIENCE:
Any combination of education and experience which would demonstrate possession of the required knowledge, skills, and abilities. An example of a qualifying education and experience is:
Revenue Integrity Manager I:

• Bachelor's degree in Health Care, Business, Public Administration, or related field, AND
• Three (3) years of recent and progressively responsible experience in Revenue Cycle administration, finance, or accounting, including two (2) years in a supervisory capacity, leading professional-level staff, or managing projects.

Revenue Integrity ManagerII:

• Bachelor's degree in Health Care, Business, Public Administration, or related field, AND
• Five (5) years of recent and progressively responsible experience in a highly complex healthcare Revenue Cycle environment in a medical system comparable to Ventura County Health Care Agency and clinics, which includes at least three (3) years supervising professional-level staff in a supervisory capacity, leading professional-level staff, or managing projects.

Substitution: Up to four (4) years of additional related experience may be substituted for the bachelor's degree.
NECESSARY SPECIAL REQUIREMENTS:

• Work experience leading critical, interdisciplinary projects
• Comprehensive knowledge of medical terminology and charting data
• Experience in data mining and data analytics in a healthcare setting
• Experience working with Cerner, including library builds, workflow, and Charge Master (CDM) management
• Excellent written communication skills must be demonstrated in the completion of the employment application and supplemental questionnaire
• Proven ability to manage workplace relationships with stakeholders at various levels of the organization.
• Must possess, or be able to obtain and maintain a valid California driver's license

DESIRED:

• A Master's degree in Business, Public, or Health Care Administration or in a related field.
• Certification from the Health Care Finance Management Association (HFMA)
• Experience as a Certified Coder or a Registered Nurse
• Experience managing multiple Revenue Cycle Management departments serving a complex, acute care provider organization
• Recent work experience managing multiple RCM departments serving a complex, acute care provider organization

KNOWLEDGE, SKILLS, and ABILITIES:
Thorough knowledge of: theories, modern principles of cost/benefit analysis, and regulatory requirements related to the revenue cycle encompassing patient business services (admitting; business office practices and methods; patient); chart systems and forms; hospital, clinic, and professional fee charging and coding, billing, and collection); laws and government regulations related to patient/client accounts, legislative/regulatory analysis; personnel management, principles of supervision and training and fiscal management, team building and conflict resolution, and strategic planning; project management and outcome measures, standards and techniques;fiscal practices and requirements related to health care, hospital, clinic, electronic health records systems such as Cerner including Centers for Medicare & Medicaid Services (CMS) regulations, Medi-Cal, and other laws and regulations common to hospital, public health, behavioral health programs operation, administration, services in California, and other similar programs; financial regulations, billing guidelines and processes such as Current Procedural Terminology Codes (CPT) codes, International Classification for Diseases (ICD)-10 codes, and Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal including Medi-Cal Provider Manuals and Health Resources Services Administration (HRSA) program rules and requirements as they relate to Federally Qualified Health Clinics (FQHC).
Ability to: manage diverse responsibilities; evaluate and analyze the potential impact of proposed policies and programs on service areas and clients and formulate effective solutions; work effectively as a member of a management team; supervise, train and mentor staff; communicate effectively orally and in writing; establish positive professional working relationships with diverse groups such as County and department executives and stakeholders; conduct analysis and prepare comprehensive financial reports and presentations; interpret, communicate, and apply health care and hospital policies and regulations; develop policies and procedures to meet ever changing needs.
Supplemental Information: Work is primarily performed in an office environment, but incumbent may be required to travel to various sites.FINAL FILING DATE: Your application must be received by County of Ventura Human Resources no later than 5:00 p.m. on Tuesday, January 23, 2024.
To apply online, please refer to our web site at www.ventura.org/jobs. If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura, CA 93009.
NOTE: If presently permanently employed in another or "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible. If interested, please click here for additional information.
Applicants must provide sufficient information under the Education/Work Experience portion of the application and supplemental questionnaire in order to determine eligibility. A resume may be attached to supplement your responses in the above-referenced sections; however, it may not be submitted in lieu of the application.
SUPPLEMENTAL QUESTIONNAIRE - qualifying: All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire may result in the application being removed from consideration.
APPLICATION EVALUATION - qualifying: All applications will be reviewed to determine whether or not the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the screening and selection process.
TRAINING & EXPERIENCE EVALUATION: A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.
NOTE: The selection process may consist of an Oral Exam, which may be preceded or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a j...