Works under the supervision of the Manager of Revenue Integrity & CDM This position assists with researching coding & billing guidelines, insurance contracts and updating the hospital Charge Description Master (CDM) to ensure accurate charge capture and compliance with third party payer requirements. Assists with maintaining charging policies and procedures that support a complaint charging process. Researches coverage and reimbursement issues as directed in CDM activity, or as assigned via other projects. As directed, disseminates information regarding billing/coding to the appropriate clinical and support departments. Assists with the distribution of billing requirements with the appropriate departments and individuals in the NHRMC external and internal environment. Ability to work with minimal supervision and has the ability to manage multiple priorities. Provides support for the CDM functions when the Manager is out of the office. May work on special projects/assignments concerning reimbursement implications on joint ventures and new initiatives as assigned.
- Assists in creating and maintaining all hospital charge codes. Responsible for build, updating and maintaining Epic assigned tables and categories.
- Maintains EPIC work queues daily, as assigned, and reviews other work queues that fall under revenue integrity. Assists revenue stewards with clearing work queues, or investigating issues, as needed.
- Reviews changes, additions, and deletions to the Charge Description Master file (CDM) and after approval, keys those changes and updates. Verifies the changes and updates were keyed and processed properly. Processes CDM requests to ensure that additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner.
4.Recommends the assignment of CPT/HCPCS codes and UB Revenue Codes to supplies and procedures, and assists with determining prices for new services and supplies. Research and recommend new charges and changes.
5.As directed, researches reimbursement and billing guidelines from payers for supplies, drugs, and procedures. Researches and resolves all Charge Description Master related code errors effecting revenue. Communicates findings to appropriate personnel.
6.Assists with the preparation of the timely implementation of the quarterly coding updates (CPT/HCPCS), periodic UB Revenue Code updates, modifier revisions, and regulatory updates related to Charge Master data. Notifies affected departments of changes, and notifies the appropriate management personnel when coding changes may impact net reimbursement, gross charges, productivity or internal processes. Works with appropriate management to assess and mitigate the impact to NHRMC.
7.Assists with the completion of the annual update/review of the CDM in a timely and efficient manner. Works with department management to ensure a seamless transition. Performs monthly reviews of the CDM to ensure UB Revenue Codes, HCPCS, CPT-4 and charge item descriptions match appropriately. Uses resources, such as nThrive, to identify necessary changes.
8.Researches and develops flow charts of Charge Codes and the flow of revenue through hospital applications and systems.
9.Assists with development of charge master policies for the Administrative Policy Manual and ensures they are current and departments are compliant. Prepares reports of non-compliant departments/issues for Coordinator review and follow-up.
10.Collaborates with the appropriate Informatics System Specialist and Clinical Subject Matter Experts (SME) to assist with maintaining the various table files within EPIC which are responsible for providing accurate CPT/HCPCS codes and revenue codes within EPIC based upon multiple payer requirements.
11.Collaborates with Reimbursement, Information Systems, and SMEs to assist with maintaining the CDM and appropriate ERX, EAP, and SUP records and their links to these records for pricing and fee schedule maintenance.
12.Works with the team to identify departments/programs highly impacted by regulatory changes which may require internal process or informatics system changes regarding charge capture. Develops a support plan to assist those departments with modifying current practices and procedures to mitigate impact to NHRMC cash flow and operations.
13.Assists in providing education and supporting information regarding CPT coding, billing and/or coverage changes to departmental and hospital personnel as needed.
14.Works with the Manager, providing modeling and impact analysis of changes in governmental program reimbursement (as assigned). and proposed charge master changes. This may include, but is not limited to, pricing analysis, new service revenue modeling and sensitivity analysis pertaining to applicable industry trends.
15.Analyzes data with the CDM and assigns accurate CPT/HCPCS and revenue codes to Charge Description Master to insure compliance with regulatory agencies. Assists with maintaining the nThrive application.
May work on special project/assignments and other duties as assigned.