JOB DESCRIPTION :|
With minimal supervision, utilizes Charge Description Master (CDM) management software to maintain a complete, accurate and standardized CDM, with uniform data elements and consistency with clinical practice; provides support, education and guidance to Clinical and Administrative Departments in order to maximize appropriate revenue for the system.
- Review and update all CPT and HCPCS codes with Clinical Departments for any needed adds, deletions, and changes, when new AMA CPT and HCPCS changes are published annually
- Conduct at least Annual CDM and Charge Capture Reviews with Clinical and Administrative Department Heads (including, but not limited to: VP, Director, Manager, Charge Capture staff), as well as ensuring the implementation of more frequent changes as needed to comply with changing payer requirements
- Monitor government and commercial payers for updates and changes to billing requirements.
- Assist Clinical Departments with creating and implementing a documented daily reconciliation process, for departments that do not already have one in place
- Work with Clinical Department to coordinate staff education for new and existing employees on the charge process. This includes new services, as well as changes related to new, revised, replaced CPT/HCPCS descriptions
- Coordinate updates to charge tickets and charge entry system dictionary edits (ITS/OE/ORM/PHARM/LABIMPAC) with Clinical Department, Information Systems, or other appropriate individual
- Identify when rebilling is needed and coordinate the rebilling process with the Clinical & Fiscal Integration Team and Patient Financial Services.
- Review, approve, and implement individual line item CDM requests within 3 business days.
- Maintain ongoing synchronization between Meditech B/AR and Craneware Chargemaster Toolkit
- Notify clinical departments of compliance issues related to services currently provided
- Work closely with hospital management and local finance support staff on various charge master issues, including revenue optimization and billing compliance.
- Assist in resolution of denials and rejections compiled from remittance detail, working with departments that have limited understanding of the coding/charging relationship in order to solve problems
- Audit charges being captured by clinical departments for accuracy and completeness
- Must be a team player with effective oral and written communication skills in dealing with staff at various levels throughout the organization
- Understanding of charge description master, managed care, hospital reimbursement, and/or billing
- High degree of intellectual curiosity and ability to 'tell the story' underlying the data
- Strong quantitative and analytic skills
- Proficiency in Microsoft Excel, Word and Access
- Ability to quickly develop expertise on payer reimbursement methodologies
- Must be flexible and be able to adjust in changing environments, including traveling to each Steward facility.
- Bachelor's degree in Health Care Administration, Business, Finance or Computer Science or equivalent experience
- Previous Meditech knowledge is a plus
Steward Health Care - 20 months ago