Description: Job Summary:
Assumes ownership and leadership over Master CDM (Chargemaster) and Fee Schedules maintenance relating to changes in government and commercial payor regulations, coding requirements, and pricing policies. Leads and coordinates all operational areas to improve process for updating and ensuring compliance to CDM. Conducts audits and reviews CDM with operational areas to ensure compliance and identify areas of opportunities for improvement. Serves as consultant to operational areas including physicians and staff on all matters related to CDM, charging and KP pricing policies. Recommends and implements changes to improve charge capture, coding, billing and pricing policies. Works collaboratively with related departments, areas and staff.
Essential Responsibilities:
Responsible for CDM master file. Ensures appropriate charge codes, procedure codes, rates, and billing codes are maintained in CDM Master. Defines services and assigns charge codes, rates, and billing codes.Ensures CDM is updated and compliant with all regulation changes.Leads regional team; meets regularly for significant matters relating to improving CDM accuracy and compliance.Performs regular reviews/audits of CDM. Ensures CDM meets organizations pricing policy requirements and is compliant, identifies deficiencies, and facilitates or makes changes as necessary to comply with policies and regulations. Identifies services being performed but not charged for or is charged inappropriately with review and discussion with clinical department personnel.Assesses requests for new services, develops related charges for billing, identifies impacts to charging/billing processes and facilitates changes.Develops and improves organizations pricing policies for all services for CDMs. Formulates pricing strategies for negotiated contracts and capitalization, collaborates with pricing department, and monitors to ensure compliance.Educates and serves as resource to departments, physicians, and practitioners on charging and responding to all inquires. Refers to appropriate department as necessary. Trains on proper CDM maintenance procedures.Analyzes UB 04 and 1500 billing issues that relate to charges/codes. Facilitates changes to optimize revenues and be compliant; collaborates with appropriate department.Establishes and monitors a process with purchasing, coding, billing, and clinical departments to ensure all new supplies have appropriate HCPC codes and related information is attached for CDM purposes.Works on special projects that assist the organization in attaining or exceeding revenue cycle and compliance objectives. Basic Qualifications: Experience
Minimum five (5) years of demonstrated experience working with hospital and physician CDMs and Fee Schedules to include analysis and evaluation.Minimum two (2) years supervisory/lead or project management experience. Education
Bachelors degree in business, finance, or related field OR four (4) years of experience in a directly related field.High School Diploma or General Education Development (GED) required. License, Certification, Registration N/A Additional Requirements:
Knowledge of medical coding.Knowledge of Federal and State Medicare/Medicaid laws and Commercial Third Party payor regulations.Demonstrated knowledge of and skill in adaptability; change management; conflict resolution; creativity/innovation; decision making; group presentations; group process facilitation; influence; interpersonal relations; oral communication; problem solving; project management; results orientation; systems thinking; team building; teamwork; written communication; organizational skills; time management; initiative; and prioritization.Demonstrated knowledge of and skill in the following PC application(s): word processing; spreadsheet; database. Preferred Qualifications:
Fee for Service health care industry experience.Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA).