Charge Master Coding Analyst

MINIMUM QUALIFICATIONS:

• Education:
• Degree in HIM, Business Administration or any Medically related field and/or Certified Professional Coder (CPC).
• 5 years minimum hospital experience
• 3 years’ experience in coding, billing, and/or patient accounting
• Knowledge, Skills
• 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.
• 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
• Percentage
• 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.
• 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.
• 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.
• 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
• Maintain Charge Description Master
• a. Creates CDMs as requested by departments.
• b. Reviews CDM requests for coding compliance.
• Billing Clarification Management
• 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.
• 5 years minimum hospital

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
• Percentage
• Of Time:
• 1.

Annual Auditing

Evaluates information from daily Charge Capture Audit system

Nurse/Department charge Audits

Special Project Management

Maintain Charge Description Master

Billing Clarification Management