Job Description

Locations: Jacksonville, Florida

Categories: Revenue Integrity

Req ID: 67892

Overview

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.

Responsibilities

Responsibilities

• To validate CPT and HCPCS Level 11 code and modifier assignments, APC grouping appropriateness,missed procedures and insure compliance with all APC mandates and outpatient reporting requirements.
• Coordinatequarterly (or as needed) chargemaster review of pricing versus fee schedule or APC payment. Coordinate the annualupdating of CPT codes. (30%)
• Monitors 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. (10%)
• Monitors compliance with department, hospital and administrative directives. Develops reports and collects and prepares data for studies involving outpatient financial impact and profitability. (10%)
• Attends outpatient coding and reimbursement workshops as approved by manager and brings back information to the appropriate departments.
• Communicates 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. (10%)
• Coordinates regular periodic APC/Chargemaster meetings to inform staff of changes in policies and to provide in-service training.
• Establishes controls and review mechanisms to ensure that system changes and procedures are being followed correctly.
• Provides and/or arranges for training of department Directors and/or their designee in use of coding within the chargemaster to insure compliance. (10%)
• Responsible for reports, studies, analyses or projects as requested by the Revenue Integrity Manager and/or Associate Administrator/CFO. (10%)
• 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. (10%)
• Insures compliance with all Federal, State and local regulations.
• Works closely with Ancillary Departments with the monitoring of their department chargemasters to insure accurate coding of procedures. (10%)

Qualifications

Required Education

High School Diploma or GED

Preferred Education bachelor's degree in business administration or healthcare administration.

• Minimum Qualification:
• Necessary Skills Must be familiar with Information Systems mapping to insure 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.

Required Licensure/Certifications

Licensed to practice nursing or practical nursing in the state of Florida OR Coding Certification