Position Summary / Career Interest:

• Maintains all inpatient outpatient and physician charge description documents to ensure that all items are a direct reflection of chargeable and billable services; initiates coordinates monitors reviews analyzes and implements requests to add change or delete CDM items as appropriate; improves efficiency by eliminating duplicate inactive or non-compliant charges thus decreasing the potential for an inappropriate charge being utilized.
• Research billing guidelines to maintain CDM compliance with Medicare and Medicaid standards; reviews and updates documents concerning procedural and coding changes and initiates action to update the hospital charge description master as necessary; performs data quality reviews on individual department charge descriptions to ensure compliance with all payer mandates and reporting requirements.
• Performs CDM quality control and troubleshooting activities; performs systematic reviews of system-generated reports to monitor charging practices and identifies potential problems; recommends workflow and other process changes to address charging problems or deficiencies; audits health care provider progress notes to ensure that appropriate charges are being reported on patient billing documents; researches and resolves complex billing issues involving rejected charges; analyzes file data for evidence of deficiencies in controls duplication fraud process breakdowns or compliance.
• Maintains and/or modifies departmental charge documents to reflect current CDM choices.
• Research industry trends regarding pricing policies and recommends adjustments to pricing strategies and policies; confers with Hospital management to analyze CDM billing processes to identify root causes of denials/underpayments and to analyze new third-party payment requirements.
• Implements CDM data entry or upload maintenance requests; works with information systems staff to ensure that the appropriate CDM information is properly loaded and placed on the claims.
• Coordinates and/or oversees projects and processes as assigned; prepares reports studies analyses and other documents as assigned; presents findings to individuals and/or groups as required.
• Performs other duties as assigned.
• Works effectively with Revenue Integrity Clinical Nurse Auditor CDM and Pricing Committees.
• Demonstrates knowledge of Coding Guidelines and Conventions (CPT/HCPCS ICD-10-CM/PCS).
• Must be able to perform the professional clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

• Bachelors Degree in Business Administration Finance or a related field of study from an accredited college or university. OR
• 8 or more years of relevant experience.
• 3 or more years of experience in a charge description master or revenue integrity related position that provided broad based knowledge of hospital financial operations including reimbursement.
• Designated Epic training to be completed within 6 months of hire

• Masters Degree in Business Administration Finance or a related field of study from an accredited college or university.
• 5 or more years Experience with medical billing and coding and/or CPC or CPC-A coding certification

• Certified Public Accountant (CPA) - State Board of Accountancy
• Certified Charge Capture Professional (CCCP) AAPC/HFMA

Time Type:

Job Requisition ID:

Important information for you to know as you apply:

• The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race color religion sex (including pregnancy gender identity and sexual orientation) national origin ancestry age disability veteran status genetic information or any other legally-protected status. See also Diversity Equity & Inclusion.

• The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process please let our recruiters know by requesting an Accommodation Request form using this link .

• Employment with the health system is contingent upon among other things agreeing to the and signing the agreement to the DRP.

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