Charge Master Coding Analyst

HealthPartners; Saint Paul (MN); Sur place; USD 80 000 - 110 000; Plein temps

Résumé du poste

Regions Hospital is seeking a Chare Master Coding Analyst who uses clinical knowledge to compare medical records documentation with billed items. The role analyzes departmental charging patterns, identifies coding and billing issues, and updates CPT/HCPC/ICD-10 codes.

It coordinates audits, prepares summary reports, and collaborates with nursing, medical records, finance, and patient accounting to improve revenue capture.

Qualifications

• Degree in HIM, Business Administration or related field and/or CPC certification.
• Minimum hospital experience: 5 years.
• 3 years’ experience in coding, billing, and/or patient accounting.
• Knowledge of medical terminology and coding guidelines.
• Excellent communication and organizational skills; ability to work independently.

Responsabilités

• Annual Auditing accounts for hospital departments and updating charges with Charge Master Manager.
• Review daily Charge Capture Audit system to identify missed revenue and implement fixes in EPIC.
• Conduct Nurse/Department charge audits to detect charging errors and document findings.
• Lead Special Projects to improve billing and revenue cycle outcomes; prepare management reports.
• Maintain and review the Charge Description Master (CDM) as requested by departments.
• Manage Billing Clarification requests and guide billing on denials and appeals.

Connaissances

Medical terminology

Coding guidelines

Investigative ability

Interpersonal communication

Organizational skills

Independent work / prioritization

Formation

HIM/Business Administration degree

CPC or RHIT/RHIA certification

Outils

EPIC

Charge Capture Audit System

Description du poste

Regions Hospital is hiring a Chare Master Coding Analyst. Uses clinical knowledge and experience to compare the medical records documentation to the individual items billed. Analyzes departments charging patterns and identifies coding and billing issues. Reviews and updates preference lists and ensures their accuracy. Provides a summary of any yearly coding changes that could impact each department. Coordinates and reports audit outcomes regarding charge errors, data processing errors, and the performance of hospital charging system. Schedules annual visits with Regions areas to address any chargemaster issues. Works directly with clinical areas regarding missing or misdirected charges and acts as a resource to assist with charging and coding issues that occur. Uses own initiative to organize work and set priorities/meet deadlines and complete assignments. Offers guidance to team members by assisting with workflow management and questions. Works closely with medical records, nursing departments, finance and patient accounting. Audits charge master details for individual departments; spot check coding compliance, revenue capture review, troubleshoots problem codes. Special projects to improve revenue cycle outcomes. Assists the chargemaster manager with training, coding and billing research and special projects. Performs other duties as assigned.

MINIMUM QUALIFICATIONS

Education

Degree in HIM, Business Administration or any Medically related field and/or Certified Professional Coder (CPC).

Experience

• 5 years minimum hospital experience
• 3 years’ experience in coding, billing, and/or patient accounting

Knowledge, Skills & Abilities

• Knowledge of medical terminology
• Knowledge of coding guidelines
• Investigative ability
• Ability to relate to many levels, such as patients, nurse auditors, and employees throughout all hospital departments.
• Excellent communication and organizational skills.
• Ability to work independently, prioritize tasks and problem-solve.

Licensure / Registration / Certification

Coding certification, such as CPC (Certified Professional Coder), or Health Information Management Certification such as RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator).

MAJOR JOB DUTIES AND TASKS

1. Annual Auditing

50%

• a. Auditing of individual Hospital department charge masters. These tasks are teamed with Charge Master Manager.
• b. On schedule or per department request compiles charge master.
• c. Reviews with Charge Master Manager all charges and updates, compliance memos, CCI edits.
• d. Reviews with nurse manager/coder charging mechanism, makes suggestions for compliance, charge ticket or preference list updates.
• e. Reviews and updates CPT, HCPC and ICD-10 codes for individual departments, communicates and educates departments on upcoming changes prior to implementation.
• f. Provides summary report on action taken to nurse manager, department coders, Patient Accounting file.

2. Evaluates information from daily Charge Capture Audit system

10%

• a. Reviews monthly bill analyzer report to identify possible missed revenue and coding errors.
• b. Works with clinical departments to identify and restore missing charges and builds edits in EPIC to prevent future missed charging.
• c. Assists in facilitating conversations with chargemaster groups across all facilities to identify trends and implement system fixes for all hospitals.
• d. Maintains vendor relationships with Charge Capture Audit System vendor, including a system support relationship, for troubleshooting, expansion, coding compliance.

3. Nurse/Department charge Audits

5%

• a. Performs defense auditing of targeted medical records in conjunction with the itemized bills for charging errors, sub-standard documentation and inaccurate procedural billing.
• b. Obtains medical records and conducts a pre-audit. Resolves as many discrepancies as possible.
• c. Memos the account on action taken.
• d. Reports audit results to departments along with recommendations for future education and training.

4. Special Project Management

15%

• a. Prepares reports as required by management regarding audit results, process improvement recommendations, systemic billing errors, and documentation concerns.
• b. Performs individual account review as requested.
• c. Reviews code usage as requested.
• d. Provides back up coding support as needed for coders

5. Maintain Charge Description Master

5%

• a. Creates CDMs as requested by departments.
• b. Reviews CDM requests for coding compliance.

6. Billing Clarification Management

15%

• a. Reviews Billing Clarification requests from Billing Team.
• b. Sends appropriate communication to department contact.
• c. Reviews coding related billing denials and provides direction to billing department on how to appeal.