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Revenue & CDM Optimization Liaison

Company: Trinity Health Corporation
Location: Athens
Posted on: June 13, 2021

Job Description:

Employment Type:

Full time

Shift:

Description:

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.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

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 limited to:

  • 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 required;
  • Provides guidance, communication and education on correct charge capture, billing, and coding processes, and local, state and federal guidelines;
  • 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 and policies;
  • Conducts special reviews for management such as those required to discover mechanics of detected fraud and to develop controls for fraud prevention;
  • 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 changes.

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.

MINIMUM QUALIFICATIONS

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 PowerPoint.

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 strongly preferred.

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 solutions.

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.

Keywords: Trinity Health Corporation, Athens , Revenue & CDM Optimization Liaison, Other , Athens, Georgia

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