Sr. Revenue Integrity Charge Description Master Coordinator (Remote)

Adventist Health•Roseville, CA

1d•Remote

About The Position

Coordinates with system and local Revenue Integrity leadership to monitor and facilitate the maintenance of assigned Charge Description Master (CDM) to support technical and operational alignment in support of accurate and timely charges. Partners collaboratively with stakeholders, providing Revenue Integrity subject matter expertise to support efficient charge alignment in compliance with state and federal regulations. Maintains alignment with system standards, governance and protocols established with Revenue Integrity leadership, supporting the implementation of system-wide standardization, special projects and strategic initiatives to meet expanding and changing needs of the organization. Acts as agent of change, in the continuous monitoring and maintenance of assigned Charge Description Master (CDM) scope, facilitating changes and training as needed, as well as communicating in a variety of settings and methods. Accountable for providing direction, education, and orientation to clinical department end users on appropriate use of charges and charge reconciliation –often partnering with applicable I.T. stakeholders on ensuring proper maintenance and use of Electronic Health Record (“E.H.R.”) system (e.g., Cerner, Epic) for charge entry and charge reconciliation. Provides clinical department managers and their charge capture staff with direction pursuant to applicable Centers of Medicare and Medicaid Services (“CMS”) and industry standard billing regulations/guidelines to ensure compliant billing and accurate/complete charge capture inclusive of acute, hospital based outpatient clinics, rural health clinics, technical and acute services.

Requirements

Associate’s/Technical Degree or equivalent combination of education/related experience: Required
Five years' relevant experience: Required

Nice To Haves

High School Education/GED or equivalent: Preferred

Responsibilities

Ensures ongoing updates to the CDM based on regulatory and/or major payer CPT/HCPCS changes in collaboration with Adventist Health Payer Contracting department and other departments as appropriate. Supports a detailed, annual review of the CDM which includes identifying CPT and HCPCS codes which have been deleted, added, or replaced; assigning CPT and HCPCS specific codes when appropriate; identifying description changes; and ensuring the nomenclature reflects the procedures performed. Assists in performing periodic billing/claim audits based on CDM complexity and risk. Researches and documents trends with a focus on identifying charging and documentation opportunities including but not limited to procedure descriptions, compliance, charge amounts, multiplier set up and reimbursement method updates; facilitates implementation efforts for corrective action of identified opportunities. Assists in process management functions which may include data gathering, analysis, and determination of the charge, charge attributes (when and how a charge is triggered, charge routing, etc.), and charging workflow for new services and products.
Provides technical assistance for charging of new services and strategic pricing initiatives. Identifies services that are reimbursable, but not being coded. Coordinates with departments any process changes necessary to eliminate improper use of codes based on direction from the Senior CDM Coordinator. Provides education about the operation of the CDM, the correct use of the charge codes, the management of the submission of charges to ensure correct posting of charges on time. Works on assignments that are difficult requiring judgment in resolving issues or in making recommendations. Works with sensitive and confidential information, often involving the interpretation of policies and procedures to guide use. Coordinates work within the confines of the organization's compliance program policies. Monitors compliance initiatives related to CDM data.
Maintains CDM for all required elements, including but not limited to assignment of applicable CPT/HCPCS coding, UB-04 Revenue Codes, and appropriate pricing. Aligns practices and updates which are compliant with changing billing and coding updates made by CMS, American Medical Association (“AMA”) and other government and commercial insurance payers, as applicable. Works closely with clinical/ancillary department charge capture staff and management to provide direction, guidance, recommendations, and education on appropriate use of CDM charges to capture charges for billable services, supplies, and medications provided during patient care, and related process development and/or improvement. Provides related education on charge reconciliation practices to clinical department charge capture staff.
Coordinate with clinical stakeholders to engage in discovery, proactive notifications and / or alignment of activities to support compliance and consistency in established workflows. Provides analytical oversight to Revenue Cycle metrics, dashboards, and associated process improvement. Facilitate and encourage clinical departments to follow established enterprise workflow standards for consistency, accuracy, and alignment with leading and compliant practices. Proactive coordination and consistent communication with service area leaders, CIS, Coding, and others across the revenue cycle to assure correct service item service code selection and charging of services. Perform accurate calculations of enterprise methodology, applying the appropriate pricing policy to each of hospital and ambulatory clinic service items. Provides related education on charge reconciliation practices to clinical department charge capture staff.
Works closely with various Information Technology Services, application teams to ensure E.H.R. system (e.g., Cerner, Epic) is updated with appropriate billing/charge codes in the CDM and front-end clinical applications/order entry systems as required to capture charges. Conducts meetings with service line clinical departments to ensure accurate charge documentation, capture and workflows processes are in place. Identifies possible weaknesses in these processes and quantifies net revenue opportunities of such weaknesses. Assists in developing, with other related departments, changes to workflow processes and provides education and training to departmental staff to achieve net revenue opportunities. Provides metrics and monitoring to departmental staff to ensure understanding and compliance to correct charging procedures. Ensures that coding, revenue codes, description nomenclature, patient billable versus non-billables, pricing, catalog development, updates (add/delete/change) and GL interfaces for all CDM items are appropriate. Coordinates ongoing monitoring and reviews to identify billing and system logic opportunities related to the CDM and facilitates the solutions for achieving the identified opportunities. Assesses and processes all requested additions and changes to the CDM and works with the requesting clinical department's leadership and Revenue Integrity team to determine whether a process change(s) will be required.
Performs other job-related duties as assigned.

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