To facilitate the development, maintenance, daily operations and continued enhancement of an integrated Charge master to meet Senior Management, Decision Support, Patient Financial Services, Professional Billing Services, Payor Relations and Enterprise-wide needs of a Medical Center dedicated to the care of infants, children and adolescents.
Oversee the maintenance of the hospital chargemaster, including the review and approval of revenue center codes, and CPT codes, as applicable. Review the Chargemaster on a regular basis for potential areas that can be stream-lined. Oversee the process for ensuring that division charge encounter forms and/or the EPIC charge capture screens and the chargemaster are in sync and updated in a timely manner.
·Training and Education
Educate and/or assist division managers in understanding their chargemaster and incorporating changes. Understand current and new services, make accurate code assignments, ensure consistency on pricing and coding throughout the compendium, etc. As pricing becomes more transparent, serve as a resource for pricing information on services, as applicable
Ensure that annual meetings are scheduled between each department and the appropriate EPIC IT Team to review their charges and the EPIC set up to ensure all charges are available for use. Communicate with Patient Financial Services and HIM management to ensure that edits resulting from the chargemaster are being corrected and updated in a timely manner. Understand CCHMC pricing methodologies and work with departments as appropriate on pricing new services or changes to services
Monitor annual cpt code changes and ensure that compendiums impacted by such changes are updated. Oversee the coordination of CPT code charge setting in conjunction with Professional Business Services to insure consistency between the hospital chargemaster and the compendium with professional service charges. Oversee the external compendium review and ensure that it is performed on a bi-annual basis. Responsible for ensuring any findings are incorporated into the chargemaster in a timely manner.
Understand billing rules and regulations and identify areas of risk in the revenue cycle. Responsible for the keeping an updated procedure manual on the chargemaster. Keep current on chargemaster related issues through monitoring of the regulatory environment, review of literature, participation in professional organizations and continuing education.
·Audit and Oversight:
Work with accounting on investigating any issues with revenue mapping to the general ledger. Coordinate quality audits related to charge capture to ensure that charges are being used correctly.
Skills & Competencies
Capable of relating to a diverse age and demographic backgrounds
Ability to organize and define problems, develop strategies, solutions and recommend action plans. Must possess a high level of organizational and work flow efficiency skills and be capable of working well independently
Computer literate and ability to use personal computer based software applications required
Strong understanding of the following codes: CPT, revenue center, pricing and hospital, professional billing, and the ability to manipulate large data sets. Must be familiar with regulations on charging, billing and coding of hospital and professional services and be able to research coverage and reimbursement issues
Good verbal, written and/or interpersonal communication skills
·Bachelor's degree in accounting, finance or a related field
·Five years of related experience
·Coding certification or registry (i.e. CCS, RHIT, RHIA )
·Previous hospital revenue cycle experience Preferred:
·Accounting or finance experience in a healthcare setting
·Previous hospital billing/reimbursement experience