Charge Master Manager - Pa Billing

Company: Springfield Clinic
Location: Peoria
Posted on: January 24, 2023

Job Description:

The Chargemaster Manager is responsible for assessment of individual and departmental compliance issues and reporting any non-compliance through the Service Line structure. Works closely with other Revenue Cycle Departments and Service Line departments to provide accurate, critical information needing immediate attention to expedite compliance and recommend revenue cycle improvements. This person will read, interpret, and distribute payer coding and reimbursement information to all departments affected to ensure regulatory compliance, as well as recommends and implements pricing changes to optimize CPT / DX codes and all other payer reimbursement.Job RelationshipsReports to Director of Revenue IntegrityPrincipal ResponsibilitiesAssessment of individual and departmental compliance issues and reporting any non-compliance through the revenue cycle organizational structure.Works closely with other Revenue Cycle Departments and Service Line departments to provide accurate, critical information needing immediate attention to expedite compliance and recommend revenue cycle improvements.This person will read, interpret, and distribute payer coding and reimbursement information to all departments affected to ensure regulatory compliance, as well as recommends and implements pricing changes to optimize CPT / DX codes and all other payer reimbursement.Manage assigned staff related to the implementation of charge master, transaction codes, and price updates as appropriateMonitor changes requested to charges, transaction codes, charge workflows and Allscripts system charging functionality.Identify potential revenue, claims, and compliance issues related to prices and charges.Work collaboratively with Finance, Reimbursement, Operations, Revenue Cycle, Information Systems & Technology, Compliance,and other stakeholders to identify charge master requirements and updates required based on changes to regulatory, coding, and contractual requirements.Develop and maintain written procedures related to establishing, maintaining, and monitoring charge processes.Establish controls and perform periodic monitoring and validation of procedures and workflows to ensure compliance with policies and procedures developed.Develop, maintain, and distribute meaningful management reports and action plan necessitated by performance noted in reports.Assist as necessary with audits and investigations conducted by Legal and Internal Audit departments.Initiate, support, and participate in continuous quality improvement initiatives.Perform data quality reviews on individual department chargemasters to validate CPT and HCPCS Level II code and modifier assignments, All CPT grouping appropriateness, missed procedures and ensures compliance with all Telemedicine mandates and outpatient reporting requirements.Coordinate the annual updating of CPT codes.Monitor compliance with department, and administrative directives.Keep abreast of new technology in chargemaster analysis and other future issues impacting the chargemaster function.Provide and/or arrange training of coding within the chargemaster to ensure compliance.Ensure compliance with all Federal, State, and local regulations.Responsible for reports, studies, analyses, or projects as requested by the VP of RC/CFO.Responsible for all aspects of managing and leading a team including interviewing, hiring, training, developing, directing work and processes, managing performance, recognizing, and rewarding employees.Education/ExperienceBachelor--------s Degree in Business, Accounting, Finance or Health Administration preferred.Coding certification required.Three to Five years management experience in healthcare accounting, finance or revenue cycle.Working knowledge of healthcare revenue cycle functions, including coding and billing guidelines, government payer regulations. Must have revenue code and CPT coding knowledge.Demonstrated knowledge of hospital pricing/charging and claims/reimbursement requirements and processes. Rural Health care billing experience a plus.Demonstrated success managing, monitoring, and optimizing information systems related to pricing, charging, and charge master systems and applications.Ability to interpret and implement regulatory standards.Licenses/CertificationsBachelor--------s Degree in Business, Accounting, Finance or Health Administration preferred.Coding certification required.Three to Five years management experience in healthcare accounting, finance or revenue cycle.Knowledge, Skills and AbilitiesExcellent interpersonal and communication skills to positively interact with a variety of personnel, including administrative and management staff.Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Excel, and Access. In addition, working knowledge of Allscripts/TW/Curves reports, Experian, RCXProficient skills to collect, organize and analyze data, produce meaningful reports, and recommend improvements and solutions.Working EnvironmentOnsitePHI/Privacy LevelHIPAA 4

Keywords: Springfield Clinic, Peoria , Charge Master Manager - Pa Billing, Accounting, Auditing , Peoria, Illinois