Responsible for ensuring the integrity of the Charge Description
Master (CDM) and the charge capture process by providing sound
advice and leadership as it relates to individual procedures
charged, CPT codes, billing requirements and compliance issues.
Coordinates and implements changes in the CDM in all information
systems and facilitates CDM requests with System Office CDM and
Compliance team. Ensures CDM codes are compliant with Medicare and
local payer guidelines.
Works with various clinical departments and physicians
throughout the ministry organization to proactively implement
changes in the charging process to enhance collection of revenue
while meeting and complying with all local, state, federal, and
third party billing requirements. Collaborates with Revenue
Integrity colleagues to perform root cause analysis on issues with
pre-billing and identifies opportunities for optimization of
revenue. May be responsible for local pricing decisions. Required
to travel between locations within the Region.
As a mission-driven innovative health organization, we will
become the national leader in improving the health of our
communities and each person we serve. By demonstrating reverence,
commitment to those who are poor, justice, stewardship, and
integrity, our organization will continue to provide better health,
better care, at lower costs.
Knows, understands, incorporates, and demonstrates the Trinity
Health Mission, Vision, and Values in behaviors, practices, and
Performs activities that relate to charge monitoring and
follow-up, as well as the set-up and maintenance of the Charge
Description Master (CDM), and support coverage of other
departmental functions. Frequent communications will occur with
Physicians, Medical Records/Health Information Management,
Ancillary, Nursing, Patient Business Service (PBS) center,
Information Services, Compliance, and Managed Care department
staffs. Charge Description Master maintenance and charge capture
monitoring and resolution responsibilities include, but may not be
- Audits Charge Master for each department on a regular basis,
including the review of appropriate coding, departmental and
pricing concerns, and any other issues deemed appropriate. Conducts
departmental interviews to ensure proper recording of transactions
and compliance with state and federal guidelines relating to the
charge capture and billing of services. Prepares and submits audit
findings and makes recommendations to management;
- Approves and assists in the implementation of charge codes and
charge practices, as well as providing input and recommendations as
it relates to charges for new services and all service lines.
Provides financial analysis and other documentation, as
- Provides guidance, communication and education on correct
charge capture, billing, and coding processes, and local, state and
- Coordinates concurrent and retrospective audits of patient
medical records and itemized bills, as requested by patient, third
party payer, or external auditors;
- Reviews facility bill rejections, edits and reports findings to
Ministry Organization leadership. Analyzes data obtained for
evidence of deficiencies in controls, duplication of effort, fraud,
or lack of compliance with laws, government regulations. Utilizes
this data to assist in the development of CDM and charge capture
policies or procedures;
- Examines, reports, and makes recommendations regarding
departmental charge activities for compliance with management plans
- Conducts special reviews for management such as those required
to discover mechanics of detected fraud and to develop controls for
- Works with Information Systems and other departments to ensure
that the appropriate Charge Description Master (CDM) and other
necessary billing data are placed on the claim appropriately, which
includes ancillary or clinical systems related to revenue cycle,
charge capture and billing, and
- Reviews bulletins to maintain an understanding of regulatory
and payer changes to assure correct charging and billing
requirements are met.
Prepares special reports and analysis as directed by leadership.
Participates and leads in committees and meetings. Serves as
liaison to Payer Strategies and System Office CDM and Compliance to
fully understand local contracts and ensure CDM alignment.
Ascertains through the systematic audits of the charge procedure
dictionary, compliance issues (bundling and/or unbundling of
charges) and makes appropriate recommendations to ensure compliance
with regulatory mandates.
Attends coding and reimbursement workshops and webinars;
communicates related information to appropriate departments and
ensures understanding and assists with applicable process or system
Coordinates pricing increases as directed by Finance and
utilizes strategic pricing applications to maximize payments within
the hospital budget requirements.
Other duties as assigned.
Maintains a working knowledge of applicable Federal, State, and
local laws and regulations, Trinity Health's Organizational
Integrity Program, Standards of Conduct, as well as other policies
and procedures in order to ensure adherence in a manner that
reflects honest, ethical, and professional behavior.
Must possess a demonstrated knowledge of charge master
maintenance, clinical processes, clinical coding (CPT, ICD-9,
revenue codes and modifiers), charging processes and audits, and
clinical billing as normally obtained through a Bachelor's degree
in Healthcare or Business Administration, Finance, Accounting,
Nursing or a related fields, or an equivalent combination of years
of education and experience.
Five (5) or more years of experience in billing, charge
documentation, charge audit or charge capture activities, or other
functions related to revenue cycle activities. Experience with CDM
oversight strongly preferred.
Proficiency with MS Excel, Access, Business Objects highly
desired and strong level of competency with Word and
Working knowledge of third party payer rules and requirements,
computer operations and electronic interfaces related to charge
documentation, capture and billing is required. Licensure /
Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials
strongly preferred. CDC (Healthcare Compliance Certification) is
Excellent verbal and written communication and organizational
abilities. Strong interpersonal skills are necessary in dealing
with internal and external customers. Comfortable leading meetings
and process improvement initiatives. Accuracy, attentiveness to
detail and time management skills are required. .
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of
hospitals and hundreds of health centers in 22 states. Because we
serve diverse populations, our colleagues are trained to recognize
the cultural beliefs, values, traditions, language preferences, and
health practices of the communities that we serve and to apply that
knowledge to produce positive health outcomes. We also recognize
that each of us has a different way of thinking and perceiving our
world and that these differences often lead to innovative
Trinity Health's dedication to diversity includes a unified
workforce (through training and education, recruitment, retention
and development), commitment and accountability, communication,
community partnerships, and supplier diversity.