Chargemaster Revenue Cycle Specialist

The Chargemaster monitors and maintains the hospital departmental chargemasters to ensure that the coding of new and existing charge codes are within applicable coding guidelines, provides reimbursement analysis, assists with billing edit resolution and provides coverage guidelines for billable services. The Chargemaster/Revenue Cycle Specialist is also responsible for monitoring and working continuously with departments to improve the hospital's revenue cycle.

1. Revenue and Reimbursement Management
   1. Insures the appropriate bundling or unbundling of charges so that all charges are submitted result in maximum reimbursement while following applicable billing, coding and reimbursement regulations.
   2. Interprets Medicare transmittals to determine whether new codes, coding changes, or directives that alter billing and compliance are required and to communicate these changes to all relevant departments.
   3. Proactively identifies new charge opportunities and makes monthly recommendations to prevent future billing problems.
   4. Manages the process of CDM maintenance including the training and supervision of staff in order to process CDM request in a timely response to decrease bill rejections and payment delays due to chargemaster driven coding and charging issues.
   5. Effectively utilizes all internal automation and software applications. Prepares reports as required by management regarding process improvement recommendations and systematic claim processing issues.
   6. Answers questions regarding hospital and departmental operations, policies and procedures.
   7. Assist Payer Relations with contract analysis to receive maximum reimbursement.
   8. Develop or modify revenue and reimbursement reports to prevent a disruption in the revenue stream.
2. Quality
   1. Safeguards the hospital against exposure to denials, penalties and fines by ensuring healthcare services are billed accurately and properly at all times.
   2. Coordinates and performs the analysis of the yearly charge change recommendations and pricing schedule changes recommended by the contracted Revenue Consultants.
3. Collaboration and Partnership
   1. Assists the billing personnel in resolving third party payor billing problems and works to streamline the revenue cycle in coordination with Department Managers, Business Office, HIM and Managed Care to increase charge capture, receive accurate payments from payers and minimize claim denials.
   2. Assists departments in coordinating, compiling and interpreting information regarding health care services and operating costs in an effort to create efficient charging practices and the capture of appropriate revenue.
   3. Performs in-house education regarding revenue cycle/indicators for Department Managers.
4. Other Duties As Assigned
   1. Performs other duties as assigned or requested.

• 5 years experience in facility chargemaster experience
• Bachelor's Degree in Business, Finance, Accounting, or related medical field OR a degree or certificate in nursing