Providence Health & Services Regional Director Revenue Integrity in California


Providence is calling a Regional Director Revenue Integrity to Providence Regional Offices in Torrance, CA

In this position you will:

Oversee the Revenue Integrity function that provides support to accurate charging and billing in compliance with state and federal regulations as described by the Center of Medicare and Department of Health Services. Building on Providence’s mission, the Regional Director creates a clear vision for the future and defines the values that underlie the day to day activities of assigned departments. Is responsible for the handling of and solving of any problems related to the Revenue Producing Departments, including but not limited to billing compliance, pricing, charge posting, charge master oversight and recommendations to ORC, and coding. Responsible for hiring, training, development and termination of assigned staff. Maintains a working knowledge of functions in this area, assuring the financial viability of the Southern California Region through timely and accurate charging and maintaining accurate and compliant charge masters. Serves as the gate keeper and primary source of Revenue Integrity and Chargemaster for the Southern California Region.

Essential accountabilities for this position are:

  • Oversees the managing of daily revenue as related to charging.

  • Ensures charges post daily.

  • Has complete knowledge of department’s daily revenue and clinical application charging sources.

  • Serves as a primary revenue integrity resource and liaison for charge producing departments, the business office, HIM-Coding, Case Management and Admitting.

  • Works closely with charge producing departments and clinical analyst to resolve any charging issues.

  • Works with revenue producing department managers to ensure charging integrity, accuracy and to develop, enhance and maintain charging integrity program(s).

  • Provides support for department managers as necessary to facilitate One Revenue Cycle (ORC) processes.

  • Collaborates with department managers to recommend charge master updates in compliance with regulatory guidelines, standardizing where possible.

  • Acts as a resource for finance leaders with regard to revenue reporting, general ledger mapping for revenue departments and other questions that arise with regard to hospital revenue.

  • Develops policies and procedures for revenue reconciliation. Provides oversight for daily revenue reconciliation and revenue auditing of charge entry processes.

  • Works with clinical department managers and staff to implement process improvement for charge capture and revenue enhancement.

  • Supports the acute CFO’s in recommended price increases, reviewing room rates, procedure and supply pricing.

  • Analyzes new procedures, reviewing potential revenue, cost and income, making recommendations and participating in decision making for the addition of elimination of services.Is a resource to the System contracting function to identify contract carve outs, CPT or specific codes, and information about new technology and procedures.

  • Oversees the management of the Revenue Integrity staff in the performance of their duties related to charge accuracy audits, revenue cycle support services, education to departments regarding proper charging and government billing edits (NCCI, MUE’s, Coding Pairs, LCD, NCD), etc.

  • Establishes and maintains an ongoing system of concurrent and retrospective billing reviews to ensure the medical records substantiate patient bills and revenue is being captured accurately.

  • Oversees insurance defense audits with third party auditors.

  • Manages patient, department and administrative requests for a variety of issues related to revenue and charge integrity.

  • Educates clinical departments on documentation, charge accuracy and charge compliance.

  • Oversees the price quote and charge estimates process as it relates to the

  • Revenue Integrity Department.

  • Responsible for making recommendations and decisions to ensure billing compliance regulations are adhered to as it relates to charging and billing. Identifies and recommends improvements/adjustments to the System

  • ChargeMaster.

  • Assists in compliance recommended audits, internal audit, and external audits (KPMG).

  • Participates in government requested audits (RAC, OIG)

  • Oversees OSHPD submission requirements, including the CDM, 25

  • Common Procedures and Annual Price increases.

  • Collaborates with ORC Revenue Integrity and Chargemaster teams.


Required qualifications for this position include:

  • Minimum of five years revenue integrity experience is required.

  • Extensive familiarity with CPT and HCPCs coding requirements, including

  • Medicare and Medi-Cal regulations, NCCI edits, etc.

  • Extensive clinical knowledge of hospital services, pharmaceuticals, medical records documentation, etc.

  • Extensive knowledge of the dynamics of charge accuracy programs.

  • Strong computer skills including working knowledge of EXCEL and WORD.

  • Ability to use Internet search capabilities, online reference sites. Ability to adapt quickly to new systems and tools.

  • Strong Knowledge of hospital, SNF, Hospice, Homecare, Physician Billing and Free standing imaging billing requirements, billing systems, payer contract parameters, proration protocols, etc.

Preferred qualifications for this position include:

  • Bachelors degree , preferably in the health care or finance fields is preferred.

  • Current California Register Nurse License, preferred.

About the Region you will serve.

The roots planted by Providence Health & Services nearly 70 years ago in Southern California run deep and have spread over the decades to bring all facets of health care to communities stretching from the arid valleys of northern Los Angeles County to the shore.

Anchored by six award-winning comprehensive medical centers, Providence Health & Services, Southern California (Providence Southern California), provides a full spectrum of care that includes not only leading-edge diagnostics and treatment, but outpatient health centers, the well-regarded Facey Medical Group and the South Bay’s Providence Medical Institute physician group, numerous outreach programs and clinics serving those in need, hospice and home care and even Providence High School in Burbank, with its Blue Ribbon college-preparatory curriculum.

San Fernando Valley:

Providence Saint Joseph Medical Center, with 446 licensed beds, is the second largest hospital serving the San Fernando and Santa Clarita valleys. Founded in 1943 by the Sisters of Providence, Providence Saint Joseph is known for its state-of-the-art technology and high quality, compassionate care. The Burbank hospital, the first Providence ministry in Southern California, also offers services through its Roy and Patricia Disney Family Cancer Center, Heart Center, Hycy & Howard Hill Neuroscience Institute, Orthopedics Department, Women's Services and Breast Health Center.

Providence Holy Cross Medical Center is a 377-bed Magnet facility. The hospital’s signature service is its renowned Emergency and Trauma care, but Providence Holy Cross also offers a full range of specialties including oncology, cardiology, orthopedics, women’s services, neonatology, acute rehabilitation and sub-acute care. And Providence Holy Cross operates outpatient centers in two neighboring communities and educational outreach to young families.

Providence Tarzana Medical Center, which joined Providence in 2008, is a 249-bed facility with an active medical staff of more than 900 physicians. The medical center established the Women's Pavilion & Resource Center in 1983, which provides women's health and maternity care in one central location. The medical center partners with the famed Children’s Hospital Los Angeles in operating its pediatrics department, pediatric ICU and one of the largest neonatal intensive care units in the San Fernando Valley.

The San Fernando Valley also includes Providence Saint Elizabeth Care Center, a 52-bed skilled nursing facility in North Hollywood; Providence Health Center, which includes the Cancer Center; Providence Holy Cross Imaging Center; Santa Clarita Surgery Center and Providence Laboratory Services.

We offer a full comprehensive range of benefits - see our website for details

Our Mission

As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.

About Us

Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Director / Executive

Location: California

Other Location(s): California-Tarzana

Req ID: 159648