Director, Revenue Compliance

Founded in 1965, UC Irvine is a member of the prestigious Association of American Universities and is ranked among the nation's top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UC Irvine has more than 36,000 students and offers 224 degree programs. It's located in one of the world's safest and most economically vibrant communities and is Orange County's second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide.

To learn more about UC Irvine, visit www.uci.edu.

The UCI Health Compliance Program is responsible for implementation of an effective compliance program consistent with the U.S. Federal Sentencing Guidelines and guidance of the HHS Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across the UCI healthcare enterprise, which includes a leading academic medical center, outpatient clinics, professional services, and clinical schools. The Program develops, implements, and enforces University policy related to UCI clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.

Under the direction of the Deputy Compliance and Privacy Officer, the Director, Revenue Compliance is a highly experienced professional responsible for setting the strategic vision and implementing and maintaining effective compliance programs. Operating in the healthcare settings, the Director, Revenue Compliance role ensures the organization is operating within all applicable laws and regulations by developing, implementing, and monitoring compliance controls and programs tailored to the complexities of healthcare services, including inpatient, outpatient, emergency, ancillary, and physician-based services. This position plays a pivotal role in identifying and mitigating legal and financial risks in areas such as licensing, scope of practice, coding, billing, reimbursement, and documentation. The Director, Revenue Compliance proactively drives a comprehensive compliance program, setting the appropriate standards, identifying potential risks, developing solutions, coordinating regulatory and compliance actions, and collaborating with senior leadership on regulatory changes and implementation of programs that promote ethical and regulatory adherence across all healthcare services billing functions at UCI Health, UCI School of Medicine, and any other affiliated hospital programs or physician groups.

The Director, Revenue Compliance will oversee and execute on projects and programs under their supervision, including internal and external billing and coding audits, compliance training, and internal investigations, ensuring all processes align with federal, state, and payer-specific regulations, such as Medicare Outpatient Prospective Payment System (OPPS), Inpatient Prospective Payment System (IPPS), Medicare Physician Fee Schedule (MPFS) and Medicaid rules.

The position will partner with clinical departments, the privacy team, HIM, and revenue integrity teams to address compliance risks through thoughtful policy creation with a strong emphasis on documentation integrity and billing accuracy. The Director, Revenue Compliance will also partner with operations and clinical informatics to ensure all strategic initiatives are integrated into operations, comply with state and federal laws, and are supported by UCI policy.

The Director, Revenue Compliance will manage a specialized team of compliance professionals who support UCI's overall mission, vision, and values through auditing and delivery of timely, ongoing regulatory guidance.

Required:

• Expert knowledge of clinical and operational issues regarding billing and coding compliance and assessing risk
• Excellent verbal and written English communication skills
• Strong hospital management skills, with progressive and in-depth expertise in regulatory compliance
• Expert understanding of legislative processes, applicable regulations, and outside regulatory agencies
• Strong analytical, organizational, and problem-solving skills, with the ability to identify system vulnerabilities and develop and apply innovative solutions.
• Strong leadership, fiscal, and operations management skills
• Excellent project management, interpersonal, and communication skills to promote, support, and introduce regulatory systems and processes across a broad spectrum of departments
• Strong ability to convey complex information clearly and concisely to all levels of staff, management, and outside personnel, with the ability to motivate, influence, and persuade others
• Proven ability to be highly adaptive and manage multiple priorities
• Demonstrated ability to: (a) Identify key issues critical to the success of a desired product/outcome; (b) Quickly research and analyze data; (c) Integrate essential information; (d) Utilize the analysis to define and test options and alternatives; and (e) Develop recommendations and justification for the most productive course of action
• Thorough knowledge of current federal and state billing and coding laws and regulations, including: Medi-Cal and other third-party payers billing guidelines (professional fee and hospital billing)
• Thorough knowledge of medical coding and billing procedures, teaching physician regulations, professional fee billing, and hospital facility billing, including CPT coding, ICD 9 and 10, modifiers, DRG's, APCs
• Bachelor's degree in business, healthcare administration or related area; and/orequivalent combination of experience and training.
• Certified Professional Coder
• Certified Professional Medical Auditor
• Certified Evaluation and Management Coder
• Certified Documentation Integrity Practitioner
• Certified in Healthcare Compliance
• Ten (10) or more years of progressively responsible healthcare compliance experience with five (5+) or more years of manager level experience and direct supervision of team members in healthcare compliance or closely related area.
• Five (5) years' experience with health care regulations, state medical and public agency privacy laws, and medical center procedures.

Preferred:

• * Master's degree in business, healthcare administration or related area.

Special Conditions:

• Must pass a background check.

Total Compensation

In addition to the salary range listed below, we offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

*Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page - https://hr.uci.edu/new-hire/conditions-of-employment.php

Closing Statement:

The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20.

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact Human Resources at (949) 824-0500 or eec@uci.edu.