EDUCATION & EXPERIENCE:Minimum Qualifications:- Bachelor's degree in finance, Business Administration, Health Care Administration, Nursing, or related field.
- Five years' related experience.in healthcare revenue management.
- An equivalent combination of education and experience relevant to the role may be considered for this position.
LICENSES, REGISTRATIONS, OR CERTIFICATIONS:- Certified Coding Associate (CCA), or
- Certified Coding Specialist (CCS), or
- Certified Coding Specialist - Physician-based (CCS-P) certification from AHIMA; or
- Certified Professional Coder (CPC), or
- Certified Outpatient Coder (AAPC-COC), or
- Certified Inpatient Coder (AAPC-CIC), or
- Certified Professional Coder - Payer (CPC-P) certification from AAPC; or
- Certified Pharmacy Technician (CPT)
JOB SUMMARY:Oversees the integrity of charge capture and the Charge Description Master (CDM) in its entirety. Works closely with the School of Medicine, Health System leaders, Revenue Cycle Operations (RCO), and Revenue Integrity to ensure accurate and timely charging, to recommend process improvements as needed, and to maximize gross revenue.
ESSENTIAL JOB FUNCTIONS:- Conduct annual strategic and operational review of the CDM.
- Develop and maintain policies and procedures for CDM maintenance, pricing updates, and charge capture processes.
- Facilitate charge router logic review with Revenue Integrity and Coding counterparts to ensure accurate assignment of charges for services performed.
- Facilitate analysis of the CDM to ensure accurate assignment of CPT/HCPCS and revenue codes to the Charge Master in order to comply with regulatory practices.
- Provide assistance and analysis to all levels of management in support of suggested, requested and/or mandated changes to the CDM.
- Assist in reviewing and reporting all revenue departments' charge volumes, posting lag days, and charge capture performance.
- Distribute coding and billing regulatory requirements and/or announcements to all applicable departments.
- Serve as a subject matter expert to Charge Master Analysts and the Revenue Integrity department for efforts to maintain the CDM and improve operational workflows.
- Hire, supervise, train and evaluate employee performance.
Marginal or Periodic Functions:- Adheres to internal controls and reporting structure.
- Performs related duties as required.
KNOWLEDGE/SKILLS/ABILITIES:- Excellent understanding of multiple clinical disciplines and charging practices.
- Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
- Knowledge of state and federal regulations as they pertain to billing processes and procedures.
- Knowledge of the principles of Information Systems in order to effectively analyze and make decisions, preferably with proficiency in Epic.
- Basic knowledge and understanding of Medicare RBRVS fee schedule, Medicare Hospital APC/OPPS fee schedules, and hospital UB revenue codes.
- Skill in effective oral, written, and interpersonal communication.
- Skill in problem solving in a variety of settings and translation of data into actionable steps.
- Skill in time management and project management.
- Ability to work efficiently under pressure.
- Ability to work independently and take initiative.
- Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
- Ability to deal effectively with constant changes and be a change agent.
- Ability to deal effectively with challenging situations
- Ability to accept responsibility and/or delegate responsibility.
- Ability to set priorities and use good judgment for self and staff.
DECISION-MAKING RESPONSIBILITY:This role is responsible for providing day-to-day guidance to Charge Master Analysts and Revenue Integrity staff as a subject matter expert, and also overseeing day-to-day CDM maintenance actions, pricing updates, and charge capture processes within established policy. Assigns CPT/HCPCS and revenue codes on the CDM to ensure regulatory compliance, and reviews charge router logic corrections identified through review with Revenue Integrity and Coding departments.
WORKING ENVIRONMENT/EQUIPMENT:Hybrid (in-office/remote) role as determined by leadership, utilizing standard office equipment.
SALARY RANGE:Actual salary commensurate with experience.
WORK SCHEDULE:Hybrid (in-office/remote) role as determined by leadership, Monday through Friday, 8 am to 5 pm.
