Chargemaster Specialist

We seek individuals who will thrive in a high-energy and collaborative environment. If you take pride in your work, are HIGH-PERFORMING, and seek to work in a true team environment where everyone's top priority is delivering quality patient care, this is the position for you.

Certification Preferred
3-5 years' experience is required
Customer service skills are required
Experience is preferred
Review codes contained in the CDM for accuracy and update to ensure proper billing submissions to Medicare, Medicaid and other third party payers. Maintain adequate controls over the process of adding, changing or deleting procedure codes and revenue codes for the CDM. Create charge capture and coding audit programs and perform audits.
1. Review all charge master maintenance requests for compliance with Presence Health policies and CMS rules, accuracy in application of the CPT coding rules, approved pricing methodology, and accurate interfacing between computer systems, and process accordingly. Document all charge master changes so as to provide an audit trail.
2. Assist all revenue generating department directors/managers in maintaining and updating their departmental charges by communicating to and educating them on regulatory changes, pricing policies, and labor rate changes, implementation of charges for new services or procedures and utilization of best practices for charge capture.
3. Identify and confirm potential charge capture opportunities, compliance issues, pricing irregularities, system interface errors and documentation deficiencies, utilizing system reports, current regulatory information, and audit information. Recommend, implement, and monitor a process improvement plan utilizing standardized process improvement tools for revenue integrity and under the direction of the Director.
4. Participate in the system-wide Charge Master Review Council by preparing charge master reports, completing charge master reviews, completing charge capture reports and providing ongoing information as requested by the Council regarding charge master and charge capture.
5. Collaborate with information systems and the CBO personnel to make certain the charge master information is placed on the Claim forms and interfaces appropriately. Maintain crosswalks and validate clinical system procedures or tests are mapped to the appropriate CDM procedure (i.e. Lynx, Pharmacy, OE, LAB, etc.) Maintain and update fee schedules related to CDM dictionary for each ministry. Maintain database of standardized charge master items across all hospital sites including professional charge master items as indicated by type of service and location.
6. Implement annual charge master changes, under direction of CFO and Executive Leadership and in accordance with system wide charge master pricing policies and negotiated contracts, by gathering pricing data, implementing system changes, and validating accuracy of the changes.
7. Educate department leadership on the use of charge master software including downloads of departmental charge master. Provide clinical department education to ensure staff is trained and understand which services should generate which procedure code (CDM).
8. Monitor reimbursement problem areas and partner with staff to resolve problems and optimize reimbursement and profitability. Monitor and respond to revenue cycle issues identified through the Claim Hold Log in a compliant manner.
9. Review, analyze and report departmental late charges, charge rejections, and charge review/edit work queues. Ensure departments implement required actions to reduce and minimize late charges by providing education and support. Escalate issues of lack of accountability or non-compliance with policies/procedures to System Manager.
10. Create and distribute departmental charge masters on a regular basis. Provide clinical department education to ensure staff is trained and understand which services should generate which procedure code (CDM).
11. Monitor departmental charge reconciliation process for compliance with daily charge reconciliation using revenue and usage reports. Identify areas of weakness, educate where appropriate and escalate non-compliance to the System Manager.
This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
o Must have:
(a) appropriate level of skill/expertise related to charge structure, (b) reimbursement, clinical practices, and system knowledge and (c) knowledge of HCPC's, CPT, and revenue codes.
o Experience researching regulations and a detailed knowledge of various payment systems and a basic knowledge of various coding systems utilized in determining reimbursement. Translate knowledge into CDM compliance and their correlation and importance relative to coding and reimbursement issues.
o Experience in auditing claims for coding compliance and charge capture issues.
o Strong project management and project coordination skills.
o Possess all skills necessary for performing in compliance with Hospital Policy,
Charge Description Master Maintenance.

Bachelor's Degree in Business, Accounting, Healthcare Management, or Healthcare Information
Three years of experience related to charge master maintenance, coding audits, CDM compliance with payer contracts and regulations, hospital charging, patient accounts receivable or medical record coding
Associate's Degree in Business, Accounting, Healthcare Management, or Healthcare Information
Five years of experience related to CDM maintenance, coding audits, and reviewing CDM compliance with payer contracts and regulations

Experience using Microsoft Excel and other Microsoft Office products
Additional software product knowledge with CDM Master, Meditech, Epic, Trendstar, and Sure Decisions
Certificates, Licenses, Registrations
> Certified Professional Coding (CPC), Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Registered Health Information Technician (RHIT) preferred.

Please apply at:
//careers.presencehealth.org Search keyword 136378

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