• Responsible for managing, coordinating, and implementing charge master (CDM) initiatives and processes to ensure revenue management and protection.
• Provides guidance to departments regarding strategic pricing services.
• Evaluates departmental CDM requests to ensure that all additions, changes, and deletions are consistent with proper hospital charging.
• Analyzes and resolves specific billing edits/errors that require clinical expertise and that are delaying claims for processing and reimbursement.
• Serves as the principal point of contact for charging issues.
• Responsible for reducing Accounts Receivable on Unbilled Accounts by working charge related errors.
• Research and resolve a variety of issues relating to charge capture. Edit claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet and satisfy timely billing.
• Represents Chargemaster issues and concerns on the various Epic design/testing/upgrade teams and committees.
• Manages CDM Epic projects including documentation, file building, testing, validation, workflow decisions, and implementation.

Clinical Skills

• Supports clinical units in charge capture, coding accuracy and revenue management.
• Works closely with clinical departments to maintain and educate for optimum charge capture and compliant billing.
• Works with the revenue producing departments to ensure ongoing coordinated consistency of CDM, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Monitors organization wide uniformity in the application of charge codes for similar products and procedures.

Compliance Skills

• Conducts annual reviews of the chargemaster to identify codes that have been deleted, added, or replaced and ensures required updates to code descriptions.
• Identifies services that are not being coded but are technically reimbursable and discusses these services and codes with the reporting manager to determine suitable action.
• Supports the corporate compliance program by verifying adherence to charge posting policies and procedures, ensuring compliance with all applicable regulatory guidelines.
• Provides oversight and response for governmental and third-party payor audits.
• Develop and maintain corporate policies related to charge capture.

Communication/Interpretation Skills

• Holds meetings to educate department managers and other staff on changes to existing charge codes, validation of inactive codes and the development of new codes.
• Audits chargemaster changes, maintains a detailed trail of these changes, and communicates any change to all applicable departments.
• Ensures that all Chargemaster changes are appropriately communicated to affected departments and modifications made in related ancillary systems.

Education and Leadership Skills

• Good communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and negotiate resolutions.
• Ability to make independent business decisions, considering both the impact to customer satisfaction and overall financial impact for the department and organization.
• Foster teamwork within the Charge Master auditing team.
• Professional attitude and ability to relate well with executive management, physicians, other care providers, patients, and others in the hospital/Network community.

KNOWLEDGE AND SKILLS:

EDUCATION: Bachelor’s Degree required.

YEARS OF EXPERIENCE: Minimum of 5 years’ experience as an analyst, preferably in a healthcare environment, with emphasis on chargemaster, revenue capture, charge auditing, reporting and reimbursement.

REQUIRED SKILLS AND KNOWLEDGE: Analytical skills required to make decisions based on the facility and clinical situation at hand. Demonstrated knowledge and experience in performance improvement. Computer Literacy – use of multiple systems. Excellent communication, critical thinking, decision making skills, and problem-solving skills. Knowledge of Epic CDM Manager/HB Resolute and Professional Billing preferred.

LICENSES & CERTIFICATIONS:

Coding certification is a plus.