The Chargemaster Analyst monitors and assists with maintenance of the hospital departmental chargemaster, to ensure that the coding of new and existing charge codes are within applicable coding guidelines. Provides reimbursement analysis and coverage guidelines for billable services to reduce or prevent future claim denials. Ensures the appropriate bundling or unbundling of charges so that all charges that are submitted result in maximum reimbursement while following applicable billing, coding and reimbursement regulations. Assists the billing personnel in resolving third party payer and other billing problems. Reviews Medicare intermediary and other third party payer bulletins to keep current on billing requirements. Provides support as needed and/or directed by the Director, Revenue Capture/Charging Compliance. Attends status meetings and communicates information to all applicable departments.
ESSENTIAL JOB RESPONSIBILITIES:
Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignment.
Identify appropriate Revenue code(s), & HCPCs codes for services/items.
Perform inpatient and outpatient reviews for appropriateness of coding and charging, including business office activities, systems function, and charging methodologies.
Documenting results of all special project work, and providing recommendations for revenue managing opportunities relating to special projects.
Decrease bill rejections and payment delays.
Performs duties timely and responds to requested and/or mandated CDM changes.
Prepares reports as required by CDM coordinator, &/or management regarding process improvement recommendations and systemic claim processing issues.
Proactively identify new charge opportunities and make monthly observations/recommendations to prevent future billing problems.
Illustrates autonomous, best CDM coding practice;
Provides consistent input into monthly observations and executive summary reports;
Illustrates proficiency in the use of all internal automation and software applications.
Investigating and documenting any potential for new program and product development, making recommendations as opportunities arise.
Illustrating creative problem solving skills through documentation of process improvement reporting and/or internal reporting mechanisms.
Preferred Bachelor Degree (or equivalent working experience) in Healthcare related field preferred. Proficient in payment review systems, hospital information systems and coding methodologies.
EXPERIENCE & SKILLS:
Preferred: Preferred Bachelor Degree (or equivalent working experience) in Healthcare related field preferred. Proficient in payment review systems, hospital information systems and coding methodologies.
EXPERIENCE & SKILLS
Strong quantitative, analytical, and organizational skills.
Ability to understand CMS (formerly HCFA) Memos and Transmittals.
Ability to understand medical records, hospital bills, and the Chargemaster.
Ability to utilize and understand computer technology.
Ability to understand all ancillary department functions for the facility.
Ability to understand insurance terms.
10% to 25%
Franciscan Alliance offers a comprehensive set of employee benefits including: competitive salary, paid time off, health, dental, vision, life and disability insurance as well as tuition assistance and a savings and retirement plan.
It is the policy of Franciscan Alliance, Inc. to provide equal employment to its employees and qualified applicants for employment regardless of race, color, sex, religion, national origin, veteran status, or physical or mental disability, or as otherwise required by an applicable local or state law. However, Franciscan Alliance, Inc. reserves a Right of Conscience objection in the event local or state ordinances violate its values and the free exercise of its religious rights. Franciscan Alliance, Inc. is committed to the principle of equal employment opportunity.