Job Description

Department/Unit:

AMHS Revenue Integrity

Work Shift:

Day (United States of America)

Salary Range:

$64,972.00 - $97,458.00Under the direction of the CDM & CGT Maintenance Manager, this position is responsible for coordinating the charge master system and function, which is a listing of hospital services and procedures and the charges associated with those procedures. This position will utilize chargemaster management software and other resources to maintain a complete, accurate and standardized charge master. This position will provide charge master expertise, support, education, guidance, and recommendations to clinical and administrative departments to optimize net revenue.

Essential Duties and Responsibilities

• Exemplifies the AMHS Values and Code of Conduct, while striving to identify compliance risk through effective and timely review of RAC Audit requests, ensuring timely appeals, as appropriate, and reporting any identified risks to Legal Services and Corporate Compliance Departments.
• Ensures immediate action is taken on any issues identified by Legal Services or Corporate Compliance.
• Builds and nurtures collaborative supporting relationships with the AMHS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system and encourages, promotes, and advocates staff to ensure integration of new processes across all departments.
• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payer needs.
• Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with revenue producing departments to ensure the ongoing coordinated consistency of the chargemaster and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Work with analysts to perform applicable analyses to understand net revenue effect of proposed charge master and fee schedule changes.
• Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments.
• Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims. Assists in researching coding issues and recommends solution to account representative. Identifies source of problem and works with analysts to implement corrective actions to ensure that the chargemaster is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement.
• Assist in strategic pricing process to optimize reimbursement within budget guidelines
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient revenue cycle and assists in development and recommendations.
• Assist in the develop and maintain policies and procedures for the CDM, Pricing Policies and charge capture processes.
• Acts as source of reference for enterprise on regulatory, reimbursement or billing changes, and develops and implements training to maintain and support compliance with federal and state regulations.
• Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist compliant charge capture practices.
• Monitors compliance with corporate, federal, and state guidelines to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.
• Performs other duties as assigned.

Qualifications

• Associate's Degree in business, Accounting or Finance - required
• Minimum of 3 years' experience in charge capture, coding, or charge description master in a hospital and/or a practice environment - required
• Epic experience - preferred
• Knowledge of healthcare revenue cycle functions, billing, and collection processes specific to the charge description master
• Knowledge of CMS local, state, and federal regulatory requirements and the various data elements associated with all types of claim forms
• Ability to identify data and analytic challenges including data integrity, appropriateness of data sample, context, and consistency between sources. Fully leverages power analytic tools
• Experience supporting Revenue Integrity initiatives specific to implementation, and/or major process improvement and redesign
• Plans effectively yet is flexible based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener.
• Demonstrated ability to manage multiple priorities and meet all established deadlines
• Excellent verbal and written communication skills
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or other certification - preferred

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Working Conditions

• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Hazards - Rarely
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Thank you for your interest in Albany Med Health System!​

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.