Charge Integrity Coordinator

Description

Summary :

The Charge Integrity Coordinator is response for supporting and maintaining the Charge Description Master (CDM) for all Nuvance Health entities, including but not limited to, 7 hospitals and 4 physicians groups across two states. Responsible for the accuracy and completeness of the CDM and the interface of charges into the system and the linking of charges and services to the clinical build. The CDM Coordinator supports the Charge Integrity team as well as the CDM Analyst role. Assists the Charge Integrity Team in the development of charge reconciliation reports and supports all audit, CDM and revenue and usage activity. Responsible for assisting in the build of the system wide CDM Tool as well as developing a process with IT to interface all charges and new codes into the billing and medical record system in order to ensure an accurate and timely Revenue Cycle. The Charge Integrity Coordinator oversees the integrity of the pricing of the CDM and the pricing maintenance in the Cerner systems and audits the charges after interfacing them in the system in collaboration with the CDM Analyst. The Charge Integrity Coordinator will be the subject matter expert relating to the CDM structure, CPT, HPHCS, revenue codes, industry trends, and deferral, state and payer regulations and guidelines.

Responsibilities :

1.Perform daily reviews / analysis of charging errors, working with all Nuvance Health hospital and physician departments. Investigates, analyzes and recommends actions and solutions for registration, coding, charge entry, cash collection, posting and balance problems.

2.Effectively support the Charge Description Master Maintenance coordination activities in a timely manner, including charge additions, CPT / HCPCS code changes, and pricing updates.

3.Work with Charge Integrity Auditors and Revenue Cycle to identify, analyze and resolve CDM-related claim submission issues. Assist in the CEWL and EBEW error resolution. The CDM Coordinator will assist in the implementation and system build of the annual price adjustment.

4.Provide full cooperation and support to internal and external auditors by providing access to data, policies or other requested material. Understands the clinical event that will allow charges to trigger and coordinates with ITG to ensure that triggers are built for all CDM codes.

5.Participate in testing, validation and implementation of all system enhancements and upgrades to ensure that functionality, validation, transparency, charge and price accuracy is maintained. Evaluates, develops, and implements computer based departmental charge processes in collaboration with operating departments and ITG.

6.Processes CDM additions, deletions and change requests in all systems, including CERNER MILLENIUM to maintain regulatory compliance and meet operational requirements.

7.Builds exploding codes in CERNER. Ensures that Providers are attached to service codes at the departmental level to ensure correct billing. Assists in the streamlining of CDM codes across Nuvance Health in an effort to reduce charge line items in accordance with the Corporate Strategy.

8.Collaborates with clinical departments and Nuvance Health resources to ensure appropriate inpatient, ancillary, clinical and billing modules are aligned with regard to standardized CDM maintenance process, quarterly and annual CPT / HCPCS updates. Identifies clinical workflows that will impact design build. Evaluates consistency of data across financial and clinical systems to ensure CDM data is interfaced appropriately and consistent.

9.The CDM Analyst provides support for special projects which includes but is not limited to, collecting and analyzing revenue and usage claim data for the hospital, physicians and provider groups in preparation for regular changes to charging, transparency regulations and an assessment of utilization changes for operational leadership.

10.Acts as a liaison with Charge Integrity, Managed Care, Access Services, Patient Accounting and the Service Lines regarding billing and pricing issues and concerns. Supports the activities of the Charge Integrity Audit Team by running reports and processing changes. Works closely with the CDM Analyst.

11.Maintain and Model Nuvance Health Values.

12.Demonstrates regular, reliable and predictable attendance.

13.Perform other duties as required.

Other Information :

• Bachelor’s Degree in Business Administration, Accounting, Health Care Information Technology, Computer Science or a related area and / or equivalent combination of training and experience.
• Minimum of three (3) years relevant experience in CDM Management or IT. Patient Accounting experience preferred.
• Coding Certification (CPC, COC, CCA, CCS, and RHIT) Preferred.
• Clinical experience a plus.
• Experience with large scale, automated patient billing systems, medical terminology and coding. Cerner CDM and Charge Capture preferred.
• In depth knowledge of electronic data interchange and claims processing, third party payer rules, reimbursement practices and regulatory guidelines. Experience working with revenue cycle information systems or system implementation teams for complex projects, application development and / or support.
• Charge Capture / Coding / Clinical Documentation analysis experience preferred.
• In depth knowledge of issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring
• Strong Excel Skills required.
• Technical knowledge of all revenue generation sources, including CDM, Charge Capture, CDI, Coding and all other related issues.
• In depth knowledge of the hospital and physician practices, procedures and all health care concepts related to healthcare revenue cycle and its component operations, including billing, collections, charge capture, coding compliance, managed care contractual terms, Medicare and Medicaid reimbursements, thirdparty reimbursements and cash management.
• Ability to interpret a large volume of data and report it in a concise, meaningful manner.
• Ability to use billing codes including CPT, HCPCS, Revenue Codes and ICD-10 codes.

Minimum Knowledge, Skills and Abilities Requirements :

Working Conditions :

Manual : Some manual skills / motor coord & finger dexterity

Occupational : Little or no potential for occupational risk

Physical Effort : Sedentary / light effort. May exert up to 10 lbs. force

Physical Environment : Generally pleasant working conditions

Company : Nuvance Health

Org Unit : 1814

Department : Charge Integrity

Exempt : Yes

Salary Range : $32.23 - $59.86 Hourly