Charge Code Master Coordinator

Weiss Memorial Hospital has been serving Chicago’s North Side and surrounding communities providing excellent health care services for over 60 years. We are a 236-bed, Joint Commission-accredited facility providing a full range of health care services to meet the needs of our diverse community. We have grown to better serve our community to include more than 450 doctors representing 42 medical specialties and more than 800 employees, all committed to providing you with personalized care. We are looking for exceptional people who share our mission and values to join our team!

JOB SUMMARY

The Revenue Integrity Coordinator is responsible to provide analytical oversight to Revenue Cycle metrics, dashboards, and associated process improvement. Provides support and insight into Revenue Cycle process improvement including charge capture, coding impact, billing, payer reimbursement and denial management. Works closely with clinical areas to effectively document services performed and understand the relationship of documentation and charging for all services provided. Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines. Utilizes independent judgment to compare actual reimbursement to expected reimbursement, review payer contract terms, claims billing, and clinical information to effectively reconcile underpaid accounts and maintain documentation to support this activity.

JOB QUALIFICATIONS

Responsible for management of the hospital and physician billing chargemaster (CDM) in coordination with PFS and Coding, Charge Description Master (CDM) set-up and charge generation process. This position acts as liaison, problem solver and facilitator for CDM issues with Administration, Insurance Companies, Clinical Departments, Health Information Management, Utilization Management, and Revenue Cycle. 3 – 5 years of Revenue Cycle experience, primarily within Charge Review.

SUPERVISION

Exercised: None. Advises the patient care team in facilitating the discharge

Received: Reports to the Director, Case Management.

JOB RELATIONSHIPS (INTERNAL/EXTERNAL)

Interacts with patients, visitors and representatives from external organizations. Adjusts patient interaction and to match each patient’s age specific developmental, educational, or other related needs.

JOB DUTIES (* denotes “essential function”)

· Conducts meetings with service line clinical departments to ensure accurate charge documentation, capture and workflows processes are in place. Identifies possible weaknesses in these processes and quantifies net revenue opportunities of such weaknesses.

· Assists in developing, with other related departments, changes to workflow processes and provides education and training to departmental staff to achieve net revenue opportunities.

· Provides metrics and monitoring to departmental staff to ensure understanding and compliance to correct charging procedures.

· Representing the hospital and clinics, ensures all locations stay abreast of payor changes that impact reimbursement to include changes in authorizations and billing. Informs those departments as applicable.

· Ensures that coding, revenue codes, description nomenclature, patient billable versus non-billables, pricing, catalog development, updates (add/delete/change) and GL interfaces for all CDM items are appropriate.

· Works with coding resources to improve clinical and reimbursement policies, procedures, laws, and regulation related to charge capture and billing. Collaborates with coding personnel for changes in reimbursement rules as part of retrospective review process and newly introduced coding/billing guidelines to standardize coding and billing processes to include CDM maintenance.

· Coordinates ongoing monitoring and reviews to identify billing and system logic opportunities related to the CDM and facilitates the solutions for achieving the identified opportunities.

· Performs or coordinates data quality reviews ensuring revenue integrity and coding compliance audits to ensure OIG compliance. Monitors compliance with all federal regulations with NCD’s and LCDs for medical necessity.

· Assesses and processes all requested additions and changes to the CDM and works with the requesting clinical department's leadership and Revenue Integrity team to determine whether a process change(s) will be required.

· Responsible for final review and approval of CDM changes before processing into the EAP; Confirms charge appropriately represents clinical services or procedure prior to creation for billing use. Ensures maintenance and reconciliation of CDM updates.

· Evaluates validate underpayment work queues and reports and documents appropriate follow-up within the system.

STATEMENT OF OTHER DUTIES

This document describes the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

All employees are required to familiarize themselves and continually comply with all federal and state healthcare laws, regulations and rules (including Medicare and Medicaid billing requirements which are applicable to the employee’s job duties). Any employee who becomes aware of possible noncompliance with applicable laws is required to promptly report such possible noncompliance to his or her immediate manager or the compliance Resource Line. No adverse action or any form of retaliation shall be taken by the Hospital against any employee because of that person’s good faith report of possible noncompliance.

Weiss Memorial Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.