EDUCATION & EXPERIENCE: Minimum Qualifications:
Bachelor's degree in finance, Business Administration, Health Care Administration, Nursing, or related field, or equivalent broad proven practical experience in healthcare revenue management and 4 years' related experience required. LICENSES, REGISTRATIONS, OR CERTIFICATIONS:One of the following is preferred but not required: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Coding Specialist - Physician-based (CCS-P) certification from AHIMAORCertified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), or Certified Professional Coder – Payer (CPC-P) certification from AAPC.Successfully complete General Compliance Coder testing.
JOB SUMMARY:
Oversees the integrity of the Charge Description Master (CDM) and maintains responsibility for updates to charge codes within the CDM. The Senior Analyst monitors quality and key metrics to ensure all activities are being completed by the CDM team in a timely and accurate manner. Oversees daily maintenance, regular updates, and price impact analyses and facilitates all changes implemented in the CDM. Works closely with the School of Medicine and Health System department managers, Revenue Cycle Operations (RCO), and the Revenue Integrity department to ensure accurate and timely charging, recommend process improvements, and maximize gross revenue.
ESSENTIAL JOB FUNCTIONS:
Oversee processing of CDM requests to ensure that all additions, changes, and deletions are consistent with proper charging, billing, coding, and pricing practices in a timely manner. Facilitate analysis of the CDM to ensure accurate assignment of CPT/HCPCS and revenue codes to the Charge Master to comply with regulatory practices. Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.Facilitate charge router logic review with Revenue Integrity and Coding counterparts to ensure accurate assignment of charges for services performed. Develop and maintain policies and procedures for CDM maintenance, pricing updates, and charge capture processes. Facilitate new department POS recommendations. Conduct annual review of the CDM and quarterly updates as appropriate. Ensure the Charge Master Analysts provide excellent customer service to departments and respond in a timely manner to all charge inquiries, updates, and requests for charge form set-up and assistance. Maintain excellent relationships with, and serve as liaison among RCO, Health System departments, School of Medicine departments and Finance team. Identify new coding sequences, as needed, for new services. Evaluate recommended charge protocols for given procedures in conjunction with reimbursement. Take initiative to identify system and/or operational problems and participate in streamlining charging workflows and optimizing current charging practices to increase revenue. Distribute coding and billing regulatory requirements and/or announcements to all applicable departments. Serve as a subject matter expert to Charge Master Analysts and the Revenue Integrity department for efforts to maintain the CDM and improve operational workflows. Hire and mentor Charge Master Analysts to support this function, conduct quality and productivity reviews of staff members, and provide feedback on performance. Provide frequent updates to leadership on staff performance, department charging issues, and current process improvement initiatives. Marginal or Periodic Functions: Adheres to internal controls and reporting structure. Performs related duties as required.
KNOWLEDGE/SKILLS/ABILITIES:
Excellent understanding of multiple clinical disciplines and charging practices. Excellent ability to understand and interpret statistical reports and perform quantitative analysis. Knowledge of state and federal regulations as they pertain to billing processes and procedures. Knowledge of the principles of Information Systems to effectively analyze and make decisions, preferably with proficiency in Epic. Basic knowledge and understanding of Medicare RBRVS fee schedule, Medicare Hospital APC/OPPS fee schedules, and hospital UB revenue codes. Skill in effective oral, written, and interpersonal communication. Skill in problem solving in a variety of settings and translation of data into actionable steps. Skill in time management and project management. Ability to work efficiently under pressure.
WORKING ENVIRONMENT/EQUIPMENT: Standard office environment and equipment.
SALARY RANGE: Actual salary commensurate with experience.
WORK SCHEDULE:
Hybrid-remote with flexibility based on departmental needs, Monday through Friday, 8 am to 5:00 pm. Equal Employment OpportunityUTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities. Compensation
