Job Summary
This position develops and maintains all patient charges for the organization, as well as identifies, audits, and resolves coding concerns, charging issues, and related operational practices for organizational entities ensuring federal, state, local regulatory and managed care compliance.
Essential Functions
Implements and maintains all changes, additions, and deletions for any charge description master revision to ensure federal and state compliance and to avoid possible severe penalties and maintain the integrity of the organizations Enterprise Standard Charge Description Master. Makes recommendations and operationalizes changes as needed. Checks formulas for applicable departments. Completes and implements price changes. Provides information regarding the development of charge description masters for new departments or service lines
Conducts internal reviews of the charge description master coding and charging practices. Identifies and resolves any issues. Provides education and training, making decisions and determinations regarding appropriateness of changes. Educates and trains personnel to ensure compliance and avoid fraud and abuse issues. Acts as a resource for corporate compliance. Prepares and operationalizes policies and procedures as identified by external sources.
Identifies the departments impacted by the annual CPT-4/HCPCS and UB04 code revisions (additions, deletions, changes, as well as other regulatory language changes). Provides information and recommendations as needed. Ensures timely updates to the charge description masters (coordinating with each applicable department at each facility) to avoid patient account denials.
Audits departments charge description masters to ensure that all patient charges are included, accurate, and complete. Communicates government payor reimbursement information for related charges to managed care for use in contract negotiations. Completes and submits state rate filing package and any revisions working with facility finance to ensure state compliance. Analyzes overall impact system wide and reports to managed care.
May participate in strategic pricing projects to ensure appropriate patient charges while maintaining budgeted revenue. May also assist in analysis of system requirements, validation and maintenance with respect to the charge description master application.
Minimum Qualifications
Must possess a strong knowledge of business, accounting and/or finance as normally obtained through the completion of a bachelors degree in business, accounting, finance or related field.
Must possess a strong knowledge and background in healthcare billing, reimbursement and coding as normally demonstrated through four years of progressively responsible experience in billing, reimbursement and/or coding. Must possess a knowledge of managed care contract and government payor compliance and reporting requirements. Technical knowledge required of CPT-4/HCPCS and UB04 codes.
Excellent organization, oral and written communication skills, as well as ability to maintain highly confidential data.
Preferred Qualifications
Registered Nurse (RN), Licensed Practical Nurse (LPN) or clinical experience and/or knowledge. Coding certification or an in-depth knowledge of medical coding.
Additional related education and/or experience preferred.
