Employment Type:Full timeShift:

Description:

POSITION PURPOSE

Responsible for ensuring the integrity of the Charge Description Master (CDM) and the charge capture process by providing sound advice and leadership as it relates to individual procedures charged, CPT codes, billing requirements and compliance issues. Coordinates and implements changes in the CDM in all information systems and facilitates CDM requests with System Office CDM and Compliance team. Ensures CDM codes are compliant with Medicare and local payer guidelines.

Works with various clinical departments and physicians throughout the ministry organization to proactively implement changes in the charging process to enhance collection of revenue while meeting and complying with all local, state, federal, and third-party billing requirements.  Collaborates with Revenue Integrity colleagues to perform root cause analysis on issues with pre-billing and identifies opportunities for optimization of revenue. May be responsible for local pricing decisions. Required to travel between locations within the Region.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Performs activities that relate to charge monitoring and follow-up, as well as the set-up and maintenance of the Charge Description Master (CDM), and support coverage of other departmental functions. Frequent communications will occur with Physicians, Medical Records/Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance, and Managed Care department staffs.  Charge Description Master maintenance and charge capture monitoring and resolution responsibilities include, but may not be limited to:

Audits Charge Master for each department on a regular basis, including the review of appropriate coding, departmental and pricing concerns, and any other issues deemed appropriate. Conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal guidelines relating to the charge capture and billing of services. Prepares and submits audit findings and makes recommendations to management.Approves and assists in the implementation of charge codes and charge practices, as well as providing input and recommendations as it relates to charges for new services and all service lines. Provides financial analysis and other documentation, as required.Provides guidance, communication and education on correct charge capture, billing, and coding processes, and local, state, and federal guidelines.Coordinates concurrent and retrospective audits of patient medical records and itemized bills, as requested by patient, third party payer, or external auditors.Review's facility bill rejections, edits, and reports findings to Ministry Organization leadership. Analyzes data obtained for evidence of deficiencies in controls, duplication of effort, fraud, or lack of compliance with laws, government regulations.  Utilizes this data to assist in the development of CDM and charge capture policies or procedures.Examines, reports, and makes recommendations regarding departmental charge activities for compliance with management plans and policies.Conducts special reviews for management such as those required to discover mechanics of detected fraud and to develop controls for fraud prevention.Works with Information Systems and other departments to ensure that the appropriate Charge Description Master (CDM) and other necessary billing data are placed on the claim appropriately, which includes ancillary or clinical systems related to revenue cycle, charge capture and billing, andReviews bulletins to maintain an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.

Prepares special reports and analysis as directed by leadership. Participates and leads in committees and meetings. Serves as liaison to Payer Strategies and System Office CDM and Compliance to fully understand local contracts and ensure CDM alignment.

Ascertains through the systematic audits of the charge procedure dictionary, compliance issues (bundling and/or unbundling of charges) and makes appropriate recommendations to ensure compliance with regulatory mandates.

Attends coding and reimbursement workshops and webinars; communicates related information to appropriate departments and ensures understanding and assists with applicable process or system changes.

Coordinate's pricing increases as directed by Finance and utilizes strategic pricing applications to maximize payments within the hospital budget requirements.

Other duties as assigned.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

Must possess a demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-9, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education and experience.

Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities. Experience with CDM oversight strongly preferred.

Proficiency with MS Excel, Access, Business Objects highly desired and strong level of competency with Word and PowerPoint.

Working knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required.  Licensure / Certification:  RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) is strongly preferred.

Excellent verbal and written communication and organizational abilities. Strong interpersonal skills are necessary in dealing with internal and external customers.  Comfortable leading meetings and process improvement initiatives. Accuracy, attentiveness to detail and time management skills are required.

Ability to work independently, and to prioritize and manage multiple functions and priorities simultaneously.

Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office and/or home office environment. The area is well lit, temperature controlled and free from hazards.

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities. Must be able to travel up to 25% to the various Trinity Health sites within region as needed.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Pay Range $31.00-$43.50 Dependent on experience and location

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.