Responsible for the development, implementation, maintenance and audit functions of a standard system focused on hospital
Charge Description Master (CDM). Ensures data integrity between CDM and hospital data files; researches coding and revenue
reporting requirements; utilizes strategic applications to maximize reimbursements within hospital budget guidelines.
Major Position Responsibilities:
- Approves all changes made to the CDM for Tri-City Medical Center
- Manages special projects relative to the charge master, billing and charge capture processes. Monitors and reports on implementation of recommended improvements. Initiates and participates in focused reviews of pricing, coding, departmental charge structure, and CDM standardization.
- Works with senior leadership to formulate pricing strategies and mark-up formulas. Coordinates with the Managers of Budget and Financial Planning and Budget Analysts to ensure appropriate CDM pricing. Participates in analyses of price relative to costs and payor reimbursement.
- Works with coding personnel and clinical managers to ensure codes in the CDM are current and accurate.
- Promotes standardization and identification of best practices by reviewing current practices within each charging area.
- Audits revenue cycle processes to promote efficiency and revenue optimization.
- Performs risk assessment to identify areas of greatest opportunity for process improvement, enhanced charge capture, billing, coding, and reimbursement.
- Recommends focused audits of revenue cycle processes.
- Provides Action plans based on findings from audit results including opportunities for process improvement and revenue realization.
- Coordinates external CDM reviews where applicable. Monitors and reports on implementation of recommendations.
- Identifies and communicates external developments affecting the revenue cycle.
- Reviews contracts and other information from 3rd party payors to identify technical billing requirements.
- Keeps abreast of regulatory changes. Develops and leads departmental process to review new regulatory developments, evaluate impact on CDM and revenue cycle processes, and communicate to other affected departments.
- Leads implementation of required regulatory changes and ongoing monitoring of success.
- Coordinates with executive management to evaluate impact of regulatory changes and prepare financial analysis as needed.
- Supports responsibility as it relates to revenue cycle.
- As appropriate, investigates or refers for investigation, potential compliance issues identified during routine reviews.
- Conducts and/or supervises routine and special compliance audits as directed executive management or compliance.
Safety and Infection Control Responsibilities
- Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.
Qualifications: (ESSENTIAL COMPETENCIES, KNOWLEDGE, & EXPERIENCE)
- General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, and CDM, charge capture, and billing processes, required.
- Understanding of compliance issues, their importance and consequences.
- Demonstrated leadership ability including ability to work in a team, build consensus, problem-solve, influence others outside a direct reporting relationship, and handle conflicts with tact.
- Requires advanced computer skills including use of e-mail, spreadsheets, word processing, databases, decision support systems, patient accounting, conduct internet searches for research, project management, and reporting.
- Minimum of 3 years experience in Healthcare billing, required.
- Bachelors degree in Business/Finance/Accounting or equivalent, required. May consider comprehensive healthcare CDM experience in lieu of education.
- Certified Coding Specialist (CCS) or Certified Hospital Procedural Coder, preferred.
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.