Covenant Health

Director Corp Revenue and Charge Processes

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary: 

Under the direction of the Vice President of Patient Account Services, the Director of Corporate Revenue and Charge Processes performs functions necessary to facilitate revenue integrity for all acute care entities of Covenant Health.  Responsible for interpretation and implementation of processes as per State/Federal Regulations and Centers for Medicare and Medicaid/Managed Care Payer Guidelines as it relates to revenue and charge processes, database integrity for charges, and revenue resources for charging, billing and coding.

The director is responsible for the organization and maintenance of the consolidated Chargemaster including providing support and education as it relates to the current and future revenue generation within the acute care hospital settings.    Creates process change by integrating new processes and evaluation of existing processes through communication with the impacted department leaders at the acute care facilities, IT, Business Office and Administration.  Includes the direction of compliance and standardization of revenue processes for the acute care facilities of Covenant Health.   

The director plans, organizes, and oversees the administration of revenue resource applications and tools that impact charging used throughout the system.  Provides support and expertise to users in the clinical, HIM and business office environments on an ongoing basis.   Responsible for evaluation of existing and proposed tools and or software that will impact the revenue generated within the system to ensure healthy revenue generation is achieved according to State and Federal Regulations.

The director provides oversight and direction of the functions necessary for implementation, standardization, and compliance of centralized charging processes. Responsible for the direction of charging departments for all acute care facility and employed physicians procedures performed in the cardiac catheterization and hybrid labs, interventional radiology, and emergency department services.

Directs facility and corporate level meetings to provide guidance, education and support for Covenant Health entities as it relates to corporate revenue and charge processes.  Provides pertinent information regarding revenue impact and compliance with Chief Financial Officers, Corporate Finance and Corporate Compliance Officer.  Holds a high degree of autonomy for errors or poor judgment pertaining to the direction of revenue processes and centralized charging departments or failure to follow set guidelines that could potentially result in a loss of funds to the hospital as well as negative impact on the financial health of the organization.  These objectives are met through the direction of all Corporate Revenue Process staff. 

Recruiter: Suzie Mcguinn || apply@covhlth.com

Revenue Process/Chargemaster

• Directs the implementation and standardization of system revenue processes for all acute care entities of Covenant Health. Ensures communication and coordination between the acute care facilities, business offices and IT departments. 
• Creates and revises Corporate Revenue and Charge Processes policies and procedures on an ongoing basis to ensure compliance with Federal and State Regulations. Facilitates implementation and revision of processes with the facility department leaders and key staff across Covenant Health.
• Directs the administration and standardization of charge creation, charge data field elements, and ongoing maintenance for all acute care facilities within Covenant Health. Responsible for the integrity and monitoring of the charge builds to ensure continued compliance with State and Federal Regulations and CMS guidelines as they relate to the Chargemaster and revenue processes.
• Consistently monitors and interprets procedural and regulatory changes issued by Federal and State Medicare, TennCare, managed care payers, and agencies communicating and coordinating with the Department Directors at all acute care facilities within Covenant Health. Leads and coordinates implementation of compliant processes as applicable across the organization related to these changes.
• Research potential compliance issues and report identified compliance issues to the Integrity Compliance Department of Covenant Health. Address and investigate as appropriate, provide department education and case resolution as it relates to the Chargemaster and Charge Processes.  Communicates activities with facility management, administration, Vice President of Patient Account Services and Integrity Compliance Officer.
• Directs and identifies revenue and charge needs and opportunities for all new departments of acute care facilities within Covenant Health including existing Covenant Departments merging into the acute care setting. Responsible for providing facility department education as it relates to Corporate Revenue and Charge Processes.
• Directs the analysis of reimbursement, cost, and usage as it relates to the pricing of procedures in the consolidated Chargemaster. Communicates findings and recommendations to the CFO/VP of the acute care facilities in Covenant Health. 
• Directs and oversees processes to support the revenue and charge integrity for the Room and Bed Master. Works in collaboration with the facility and corporate leadership to determine compliance for appropriate revenue based on the level of service provided in each nursing unit.  Works in collaboration with the IT Clinical Access Team to ensure that the tables are built appropriately based on the needs of the facility.
• Directs internal controls to ensure that the integrity of the consolidated standardized Chargemaster is adhered to at all times. Ongoing monitoring of user access and changes for appropriate use of the chargemaster tables.  Build and maintain indicators to evaluate and monitor the ongoing performance of the electronic Chargemaster form and workflow process. 
• Provides ongoing communication and support to all corporate departments, i.e. cost accounting, finance, billing, compliance, information systems, decision support, internal audit and facility leadership as it impacts the integrity of corporate revenue and charge processes.
• Coordinates with the IT department to implement system charge process change to increase the integrity and efficiency in healthy revenue generation within all acute care entities of Covenant Health.
• Represents Corporate Finance and actively participates with Facility Department Directors on System Compliance Teams on an ongoing basis.{i.e. Emergency, Radiology, Lab, Cardiac, and Outpatient Therapy Compliance Teams}
• Collaborates with the revenue integrity department to identify target areas for process improvement. Report results and educational opportunities with affected department management.  Communicates activities with facility CFO/VP, Vice President of Patient Account Services and if applicable, Integrity Compliance Officer.

Centralized Charge Process 

• Directs and oversees all centralized charging functions for acute care facilities in Covenant Health for procedures performed in cardiac cath labs, interventional radiology, hybrid labs, and emergency department services.
• Directs and implements processes to support the ongoing communication of centralized charge functions and concerns to the appropriate corporate and facility Leadership.
• Continuously monitors accuracy and integrity of revenue generated in centralized charge departments.
• Directs resolution of any delays, issues, and/or concerns related to charge processes in collaboration with   Corporate and Facility Leadership.
• Provides direction for charging functions for procedures performed by employed physicians in the cardiac catheterization and hybrid labs in the acute care facilities of Covenant Health.
• Collaborates with Covenant Medical Management to provide ongoing support and education to employed physicians regarding compliance and integrity of procedural charging.
• Directs functions for claim resolution through delayed claims process for all centralized charge processes.
• Continuously monitors and analyzes all audits performed of centralized charge processes and develops action plans if necessary to facilitate appropriate charging practices and educational opportunities.
• Directs and oversees selection and implementation of all technology associated with improving accuracy and efficiency of all centralized charge functions.

Minimum Education:           

Strong hospital financial background with emphasis on Chargemaster, billing, and hospital work flow required. Experience in Health Information Management, Business Office Process, preferred. Bachelor's Degree in related field, such as accounting, finance or health care related field such as CPA, BSN, or RHIA, or an equivalent combination of post-secondary education and directly-related professional-level work experience. 

Minimum Experience:         

Eight (8) years of increasing responsibility or related work experience is required which included a minimum of five (5) years of direct experience involving the assignment, review, analysis and/or audit of hospital/healthcare diagnosis and procedure codes.  Experience in healthcare environment required with knowledge of Medicare, Medicaid, and third party payers, rules and regulations.  Demonstrated written and verbal communication.  Skill in establishing and maintaining effective working relationships with both corporate and clinical departments.  Basic Microsoft Office software skills, including Microsoft Access.  Expert knowledge of Coding {ICD-9-CM, CPT4, and HCPCS}.  Expected to perform adequately within the position after working at least three to six (3-6) months on the job. 

Licensure Requirement:      

Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification preferred.