Charge Description Master Technician

RiseMe; Tuba City (AZ); On-site; USD 60,000 - 85,000; Full time

Job summary

The Charge Description Master Technician (CDMT) at TCRHCC is responsible for maintaining the hospital and ambulatory clinic chargemaster, ensuring compliant pricing and accurate reimbursement across services.

You will work with service area leaders, a Coding Supervisor, and the Revenue Integrity Coordinator to ensure correct service item codes and pricing, and you will develop training to keep staff updated on coding changes and regulatory requirements.

Qualifications

• Must have High School Diploma or GED.
• Minimum two-year experience in financial or clinical service areas.
• Minimum one-year experience in patient access, billing, AR, or medical coding; RN/LPN substitution allowed.
• Knowledge of ICD-9/10 and CPT/HCPCS coding and billing procedures.
• Ability to access and use multiple data systems; proficient with spreadsheets.

Responsibilities

• Analyzes and verifies charge selection accuracy for clinical service areas.
• Maintains and updates the Charge Description Master for accurate pricing and reimbursement.
• Analyzes CDM charges for appropriate coding and pricing to reduce denials.
• Develops and delivers training on CDM changes and regulatory updates.
• Collaborates with departments and Compliance to communicate regulatory changes.
• Prepares reports on denials, underpayments, and CDM issues; resolves with appropriate teams.

Skills

ICD-9/ICD-10 knowledge

CPT/HCPCS coding

Financial analysis

Effective communication

Team leadership

Problem solving under pressure

Data interpretation

Education

High School Diploma or GED

Tools

MS Excel

MS Word

Job description

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affid ... Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

Overview

POSITION SUMMARY

The primary responsibility of the Charge Description Master Technician (CDMT) is the Hospital and Ambulatory Clinics chargemaster maintenance. The charge master maintenance is a continuous process that ensures all services are accurately charged and that the hospital and ambulatory clinics are compliant with government regulations for pricing and provides assurance that the organization receives accurate reimbursement. The CDMT must work with service area leaders and providers along with the Coding Supervisor to assure correct service item service code selection and charging of services. The CDMT must have mathematical skills and apply the appropriate pricing policy to each of the hospital and ambulatory clinic service items. Responsibilities will also include coordination of Charge Description Master tasks with the Revenue Integrity Coordinator for the purpose of two-way communication to the Clinical Service Leaders. The CDMT will provide assistance to the Director of Revenue and Reimbursement as applicable.

Qualifications

NECESSARY QUALIFICATIONS

Education

Must have High School Diploma or GED

Experience

• Minimum two-year experience in financial or clinical service areas.
• Minimum one-year experience as a patient access specialist, client service technician, medical billing, accounts receivable technician in a tribal or non-profit healthcare patient accounting setting, or medical coder. Experience as an LPN or RN may substitute patient access specialist, client service technician, medical billing, accounts receivable, or Medical coder.
• Demonstrated knowledge of ICD-9 and ICD-10, and CPT/HCPCS coding/billing procedures, Uniform Hospital Discharge Data definitions regarding diagnostic and procedural sequencing in order to interpret and resolve problems based on information derived from system monitoring reports and the UB-04, HCFA-1500, and ADA billing forms submitted to the third-party payer
• Computer skills; ability to access and use multiple data systems.

Other Skills and Abilities

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Knowledge of team dynamics and the process of building consensus.
• Detailed knowledge of various third-party payment systems.
• Skill in using personal computers for financial analysis (spreadsheets).
• Skill in performing research with bibliographic data bases and Internet access to associated information resources.
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences and no reported attendance issues
• Ability to plan and lead effective team meetings and training
• Possess expertise in professional communication, interpersonal, organizational leadership and team building skills
• Possess excellent customer services skills for internal and external customers
• Ability to work under pressure and making quality and effective decisions
• Ability to positively motivate individuals and teams to meet or exceed department expectations/goals.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical

The work is primarily sedentary with the following physical requirements; prolonged ability to sit, stand, walk, drive, maintain balance, reach; and, frequent ability to twist. Must have ability to stoop, bend, kneel, crouch occasionally; and pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, calculator, printer, fax, etc. Must have the ability to utilize hands occasionally in simple grasping, firm grasping, and, fine manipulation. Must be able to utilize a keyboard for a prolonged period with repetitive movement of fingers. Position may be exposed to prolonged infectious diseases and possible frequent exposure to chemical agents.

Mental

Exercise a high degree of judgment and leadership in planning, organizing, staffing, directing, evaluating and business office activities. Work is reviewed for conformance to policies, procedures, and practices relating to business offices practices. The employee must have the ability to organize, set priorities, develop, and implement solutions, motivate employees, and operate the department according to the constraints of The Joint Commission, budget, and regulatory agencies. Ability to interact between all disciplines within the facility is required. Must be able to frequently cope with high levels of stress, make decisions under high pressure, cope with anger/fear/hostility of others in a calm way; and work in areas that are close and crowed. Incumbent must have prolonged ability to concentrate; handle a high degree of flexibility; handle multiple priorities in stressful situation; work alone; demonstrate high degree of patience; and, adapt to shift work.

Responsibilities

ESSENTIAL FUNCTIONS:

1. Analyzes and verifies charge selection accuracy as performed by the clinical service areas
2. CDMT much keep abreast of coding and reimbursement changes to ensure the hospital and ambulatory clinics optimize reimbursement and reduce claim denials and charge coding errors that assure the accurate maintenance of the charge description master
3. Analyzes charges in the Charge Description Master (CDM) for appropriate coding and pricing.
4. Utilizes resources within TCRHCC including output of charge review consultants and regulatory agencies for correct coding practices and new charges.
5. Develops and implements training required to educate TCRHCC associates of changes, updates and additions to the CDM. Coordinates training resources to provide training at staff meetings, in-services and more formal training when necessary.
6. Works with TCRHCC Compliance Officer to analyze, interpret, distribute and communicate regulatory and contractual changes to TCRHCC departments as necessary including but not limited to action(s) required for compliance.
7. Maintains database to track and monitor regulatory changes.
8. Maintains records of action(s) required, accountability and compliance.
9. Proficient with MS Excel and Word software applications.
10. Develops collaborative relationships with all departments at TCRHCC.
11. Performs quality monitoring of required action of regulatory changes.
12. Prepares and analyzes reports on a regular and ad-hoc basis related to denials and underpayments. Works with appropriate staff to resolve CDM and charge-related billing denials.
13. Reviews charging errors identified by Medical Records and Patient Finance and works with originating departments for resolution.
14. Ensures that charges are entered in a complete and timely fashion to eliminate late charges.
15. Seeks automated reporting solutions when available. Prepares reports using spreadsheets and database solutions when necessary. Prepares and implements special reports and projects as assigned by the TCRHCC Revenue Cycle Director.
16. Organizes In-service sessions to include clinical personnel and outside agencies when necessary. Assesses needs for training materials and ensures availability of appropriate materials and resources.
17. Ensures regular meetings are conducted with PFS staff to provide In-service training on relevant issues as well as departmental and TCRHCC information. Notifies employees throughout TCRHCC of CDM process and system changes or updates.
18. Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
19. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
20. Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction.
21. Performs other duties and special projects as assigned or required.