Charge Master Analyst

About the role

This position is responsible for coordinating the charge master system and function, maintaining a complete, accurate and standardized charge master, providing expertise, support, education, guidance, and recommendations to clinical and administrative departments, and ensuring compliance with government and third-party payer policies.

Responsibilities

• Builds and nurtures collaborative relationships with the AMHS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system.
• Ensures immediate action is taken on any issues identified by Legal Services or Corporate Compliance.
• Reviews, identifies, and analyzes necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with revenue producing departments to ensure the ongoing coordinated consistency of the chargemaster and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payer needs.
• Conducts annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments.
• Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims.
• Assists in researching coding issues and recommending solutions to account representatives.
• Identifies source of problem and works with analysts to implement corrective actions to ensure that the chargemaster is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement.
• Assists in strategic pricing process to optimize reimbursement within budget guidelines.
• Participates in ongoing coordination and resolution of revenue issues as they arise.
• Aids in troubleshooting and resolving issues related to the patient revenue cycle and assists in development and recommendations.
• Aids in the development and maintenance of policies and procedures for the CDM, Pricing Policies, and charge capture processes.
• Acts as a source of reference for enterprise on regulatory, reimbursement, or billing changes, and develops and implements training to maintain and support compliance with federal and state regulations.
• Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist compliant charge capture practices.
• Maintains compliance with corporate, federal, and state guidelines to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.
• Performs other duties as assigned.

Requirements

• Associate's Degree in business, Accounting or Finance - required
• Minimum of 3 years' experience in charge capture, coding, or charge description master in a hospital and/or a practice environment - required
• Epic experience - preferred
• Knowledge of healthcare revenue cycle functions, billing, and collection processes specific to the charge description master
• Knowledge of CMS local, state, and federal regulatory requirements and the various data elements associated with all types of claim forms
• Ability to identify data and analytic challenges including data integrity, appropriateness of data sample, context, and consistency between sources
• Fully leverages power analytic tools
• Experience supporting Revenue Integrity initiatives specific to implementation, and/or major process improvement and redesign
• Plans effectively yet is flexible based on the atmosphere and needs of the audience
• Connects with the group. Is masterful and an engaging listener
• Demonstrated ability to manage multiple priorities and meet all established deadlines
• Excellent verbal and written communication skills
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or other certification - preferred

Qualifications

• Equivalent combination of relevant education and experience may be substituted as appropriate

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently
• Working Conditions
• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely