Charge Master Reimbursement Specialist

Job Description

 

 

The Chargemaster Reimbursement Specialist is responsible for maintaining an accurate and complete charge master ensuring appropriate reimbursement and compliance with governmental billing regulations. CDM maintenance includes updating CPT and HCPCS codes, updating revenue codes, as well as updating charge descriptions and pricing. Performing the essential duties, responsibilities and primary functions of Charge Master maintenance assists and supports both the clinical and financial viability of Midland Memorial Hospital. This position will endeavor to monitor compliance with all payers maintaining the integrity of Midland Memorial Hospital. Works closely with HIM coders, Department Heads, Compliance Officer and Billing Manager to monitor CPT/HCPCS code usage and charges verses payer reimbursement. The incumbent will perform a variety of tasks that require exercising sound independent judgment and initiative. This position is also responsible for Revenue Integrity Audits including chart reviews and insurance defense audits subsequently reporting any significant findings to responsible parties.

 

SHIFT AND SCHEDULE

Monday - Friday: 8:00 AM – 5:00 PM

 

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Manages all internal and external audits related to but not limited to revenue integrity, the CDM and its components. The Chargemaster Reimbursement Specialist is the point person for all Revenue Integrity Audits.
• Ensures accurate establishment of clinical charges, descriptions and billing codes in the chargemaster. Ensures accurate cross-walk of chargemaster details with underlying clinical systems used for charge capture and clinical documentation. Ensures compliance with pricing policy.
• Manages and conducts financial reviews to determine charge capture accuracy and comprehensiveness. Reviews include observance of operational procedures, documentation reviews, validation of data entry and final data capture and other aspects of operational audits.
• Provides guidance to and supports clinical departmental needs on questions, process, status and planned changes or updates to the chargemaster. Manages communication of routine changes to coding and billing protocols to affected clinical departments

 

EDUCATION AND EXPERIENCE

• Graduate of a two-year degree in health information technology or nursing or experience for two years as a CPT coder in a hospital environment.
• Excellent written and oral communication skills
• Must be proficient in Microsoft for Windows (Outlook Excel and Word)
• Must be able to type 35 wpm.
• Preference given to applicants with advanced coding certification (CCS or CPC)

 

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.