Specialist-Chargemaster Position Available In Shelby, Tennessee

Overview Develops and maintains a program of CDM maintenance and support services for Baptist Memorial Health Care Corporation. The scope includes coding updates to the charge master and support systems, including audits of code usage, and charging process. Provides direction pertaining to CDM Codes and charging guidelines to the full spectrum of leadership throughout the organization, end users, and Baptist One Care analyst to assure accurate charging and billing practices across the corporation for all Hospital Based facilities and departments. Responsibilities

• EPIC WQ Ownership for

CDM Team:

$0 Charge, Charge Not Valid, Missing Cost Center, Not Allowed Cost Center, Supply Biologicals, Service Date Out of Range, $0 Medications, Lab Z-Code Assignment, Pending Charge DNB.

• As charge error trends is identified in all WQ daily review, CDM analyst will coordinate with clinical leadership and BOC team to ensure documentation and charging practices are being followed correctly.
• Understands Medicare, Medicaid, and managed care-billing requirements, reimbursement methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges.
• Works with clinical department leadership to ensure the completeness, accuracy, ease of use, and maintenance of their specific department charge master, in conjunction with BOC team.
• Validates special projects with Baptist One Care analyst and clinical leadership to ensure documentation requirements support the charge for the service performed. Also validates the charge capture processes for the end user to take full advantage of the system capabilities.
• Coordinates all new charge code additions, deletions, and updates to the master CDM file in the EPIC system as needed and ensures the quality of the work.
• Working knowledge on revenue code assignment to all hard coded procedures and supply related charges as recommended by UB Editor.
• Working knowledge on pricing methodology as it pertains to new procedures, existing procedures, supplies, implantable items, skin substitutes, and pharmacy charges as stated in our CDM pricing policy.
• Working knowledge on the routing assignment of the revenue for procedures and supplies to specific departments based on facility specifications and design within the Cost Center Assignment Table within EPIC.
• Working knowledge on the correct

CPT/HCPCS

assignment to a specific procedure and/or supply based on CMS, NCCI, and AMA guidelines.

• Routinely works with clinical departments, coding, patient financial services, registration/admitting, managed care, finance, corporate compliance, Baptist One Care, and outside vendors to design and implement improvements as needed.
• Working knowledge of locating policy changes that are impacting charging, coding and billing through online websites and newsletters for Medicare, Medicaid and Payer website and communicates those findings to leadership.
• Will conduct monthly review of sources of lost revenue to identify trends in charge entry, billing, coding or contracting practices related to charge capture. Then works with the appropriate department(s) to address the issue. Escalates compliance concerns to manager and corporate integrity appropriately.
• Working knowledge on the institutional and professional claim forms fields and values, multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
• Working knowledge on the nThrive tool in validating the CDM data sent from EPIC to nThrive for validation and maintenance for the CDM Master file.
• Accepts other duties as assigned to promote the accomplishment of organizational goals.

Requirements:

Education

• Associates Degree or minimum 5 years equivalent experience working in a healthcare setting.
• Preferred – Bachelor’s degree specific to HIM, Nursing, Management, Information Systems, Clinical Discipline, or Finance. Experience
• 3-5 years charge description master, coding, clinical, billing, audit, compliance, revenue integrity, or healthcare finance.

Preferred:

5 years + Specific to Charge Description Master Licensure/Certification/Registries

Preferred:

LPN, RN, AAPC

Certified Professional Coder (CPC), RHIT, RHIA, RRT, RPSGT, RT, or other clinical designation.

REQNUMBER

32311