Specialist - Chargemaster Epic Certified

Summary

Develops and maintains a program of CDM maintenance and support services for Baptist Memorial Health Care Corporation. The scope includes coding updates to the charge master and support systems, including audits of code usage, and charging process. Provides direction pertaining to CDM Codes and charging guidelines to the full spectrum of leadership throughout the organization, end users, and Baptist One Care analyst to assure accurate charging and billing practices across the corporation for all Hospital Based facilities and departments.

Responsibilities

• EPIC WQ Ownership for CDM Team:$0 Charge, Charge Not Valid, Missing Cost Center, Not Allowed Cost Center, Supply Biologicals, Service Date Out of Range, $0 Medications, Lab Z-Code Assignment, Pending Charge DNB.
• As charge error trends is identified in all WQ daily review, CDM analyst will coordinate with clinical leadership and BOC team to ensure documentation and charging practices are being followed correctly.
• Understands Medicare, Medicaid, and managed care-billing requirements, reimbursement methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges.
• Works with clinical department leadership to ensure the completeness, accuracy, ease of use, and maintenance of their specific department charge master, in conjunction with BOC team.
• Validates special projects with Baptist One Care analyst and clinical leadership to ensure documentation requirements support the charge for the service performed.Also validates the charge capture processes for the end user to take full advantage of the system capabilities.
• Coordinates all new charge code additions, deletions, and updates to the master CDM file in the EPIC system as needed and ensures the quality of the work.
• In-depth knowledge on revenue code assignment to all hard coded procedures and supply related charges as recommended by UB Editor.
• In-depth knowledge on pricing methodology as it pertains to new procedures, existing procedures, supplies, implantable items, skin substitutes, and pharmacy charges as stated in our CDM pricing policy.
• In-depth knowledge on the routing assignment of the revenue for procedures and supplies to specific departments based on facility specifications and design within the Cost Center Assignment Table within EPIC.
• In-depth knowledge on the correct CPT/HCPCS assignment to a specific procedure and/or supply based on CMS, NCCI, and AMA guidelines.
• Routinely works with clinical departments, coding, patient financial services, registration/admitting, managed care, finance, corporate compliance, Baptist One Care, and outside vendors to design and implement improvements as needed.
• Working knowledge of locating policy changes that are impacting charging, coding and billing through online websites and newsletters for Medicare, Medicaid and Payer website and communicates those findings to leadership.
• Prepares and conducts educational services and communication to departments and staff pursuant to audit findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes.
• Yearly review of Charge Description Master File for yearly price increase to meet budgetary concerns as directed by senior finance leadership.
• Will conduct monthly review of sources of lost revenue to identify trends in charge entry, billing, coding or contracting practices related to charge capture. Then works with the appropriate department(s) to address the issue. Escalates compliance concerns to manager and corporate integrity appropriately.
• In-depth knowledge on the institutional and professional claim forms fields and values, multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
• In-depth knowledge of the nThrive tool in validating the CDM data sent from EPIC to nThrive for validation and maintenance for the CDM Master file.
• Serves as Leader and/or Project Director for special projects related to CDM data, reimbursement, edit and rejection reductions and regulatory issues.
• Accepts other duties as assigned to promote the accomplishment of organizational goals.

Responsibilities Specific to Certification Requirement:

• Review CDM EPIC build tracker request from other analyst for quality prior to data input into the EPIC system.
• Utilize the POC-Point of Concept, TST- Test, PRD-Production EPIC Environment for initial build prior to final import.
• Build new 10 digit EAP charge codes into the EPIC system with appropriate CPT/HCPCS, Revenue Code, Billing Category, FSC's, Cost Centers, RVU's, and other required fields.
• Update and make changes to any existing EAP charge codes as needed.
• Build Alternate CPT/HCPCS Codes and Alternate Revenue Codes required by payer, cost center, or department.
• Compile a master CDM import excel document each year prior to the beginning of the fiscal year for a price increase across the board on all billable procedures for hospital Fee-Schedules.

Requirements, Preferences and Experience

Education

• Bachelor's degree or minimum 10 years equivalent experience working in a healthcare setting.
• Preferred - Bachelor's degree specific to HIM, Nursing, Management, Information Systems, Clinical Discipline, or Finance.

Experience

• 2-5 years charge description master, coding, clinical, billing, audit, compliance, revenue integrity, or healthcare finance.
• Preferred:5 years + Specific to Charge Description Master

Licensure/Certification/Registries

• Required: EPIC Certification - Resolute Hospital Billing Charging
• Preferred:LPN, RN, AAPC Certified Professional Coder (CPC), RHIT, RHIA, RRT, RPSGT, RT, or other clinical designation.

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

• Competitive salaries
• Paid vacation/time off
• Continuing education opportunities
• Generous retirement plan
• Health insurance, including dental and vision
• Sick leave
• Service awards
• Free parking
• Short-term disability
• Life insurance
• Health care and dependent care spending accounts
• Education assistance/continuing education
• Employee referral program

Job Summary:
Position: 17787 - Specialist - Chargemaster Epic Certified
Facility: BMHCC Corporate Office
Department: HS Revenue Process & Analysis Corporate
Category: Information Systems
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:TN:Memphis
Located in the Memphis metro area