Chargemaster Coordinator | Revenue Integrity

UF Health•Jacksonville, FL

About The Position

Responsible for managing and maintaining the hospital chargemaster to insure consistency and accuracy in claims processing and data collection. Read, interpret and distribute payer coding and reimbursement information to all departments affected to ensure regulatory compliance. Establishes and maintains appropriate internal and external working relationships, and represents the hospital in a professional manner.

Requirements

High School Diploma or GED
Must be familiar with Information Systems mapping to ensure appropriate codes map to chargemaster to bill.
Must have an extensive background in CPT and HCPCS coding, third party billing and reimbursement.
Must be able to read, interpret, apply and distribute to appropriate personnel, regulations and information obtained from various State and Federal sources.
Must be able to explain to appropriate personnel how their chargemasters translate into codes that translate into reimbursement.
Must be proficient in EXCEL spreadsheets and WORD processing applications.
Must be able to work independently and use good judgment when making decisions/recommendations regarding changes/additions and/or corrections to the chargemaster.
Must be considered a resource to all departments regarding charge items/services/procedures.
Licensed to practice nursing or practical nursing in the state of Florida OR Coding Certification

Nice To Haves

Bachelor's degree in business administration or healthcare administration.

Responsibilities

Validate CPT and HCPCS Level 11 code and modifier assignments, APC grouping appropriateness, missed procedures and ensure compliance with all APC mandates and outpatient reporting requirements.
Coordinate quarterly (or as needed) chargemaster review of pricing versus fee schedule or APC payment. Coordinate the annual updating of CPT codes.
Monitor outpatient procedures and ancillary APCs assigned in the facility to Medicare assigned APC groups.
Evaluate any reimbursement change and take appropriate steps in collaboration with the right department to effect resolution of the variance.
Monitor compliance with department, hospital and administrative directives. Develop reports and collect and prepare data for studies involving outpatient financial impact and profitability.
Attend outpatient coding and reimbursement workshops as approved by manager and bring back information to the appropriate departments.
Communicate all APC updates published in third-party payer newsletters/bulletins and provider manuals to all relevant staff.
Ensure that everyone has the necessary resources, i.e.: CPT/HCPCS level 11 manuals, fee schedules to evaluate their department chargemaster.
Keep abreast of new technology in chargemaster analysis and other future issues impacting the chargemaster function.
Coordinate regular periodic APC/Chargemaster meetings to inform staff of changes in policies and to provide in-service training.
Establish controls and review mechanisms to ensure that system changes and procedures are being followed correctly.
Provide and/or arrange for training of department Directors and/or their designee in use of coding within the chargemaster to ensure compliance.
Responsible for reports, studies, analyses or projects as requested by the Revenue Integrity Manager and/or Associate Administrator/CFO.
Assist the billing office and the coding department with resolving issues or denials that are chargemaster related.
Research billing, coding and pricing requirements when new procedures and or products are introduced.
Ensure compliance with all Federal, State and local regulations.
Work closely with Ancillary Departments with the monitoring of their department chargemasters to ensure accurate coding of procedures.