Yale New Haven Health System

  • SR CHARGEMASTER

    Job Locations US-CT-New Haven
    Job ID
    64664
    Department
    REVENUE MANAGEMENT
    Category
    FINANCE
    Position Type
    Full Time Benefits Eligible
    Scheduled Hours
    40
    Work Schedule
    DAYS
    Work Days
    MON-FRI
    Work Hours
    8-430
    Work Shift
    AS NEEDED
    Requisition ID
    2018-18219
  • Overview

    To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

    Responsible for supporting hospital pricemaster development and enhancement. Ensures accurate and timely capture and transfer of charges from multiple hospital information systems into current billing systems. Scope of activities include accurate establishment of clinical charges and billing codes, researching and resolving charge system problems and analysis of current systems for purposes of identifying system improvements. Analyzes and implements relevant, periodic regulatory changes. Documents system performance, to ensure accuracy, compliance and to enhance revenue. Works as part of a multi-disciplinary team that includes billing, medical records, coding, compliance, clinical leadership, finance and information systems. At times, leads projects for the team. Trains staff responsible for charging and coordinates with several other departments in the development of improved systems. Adheres to all regulatory, departmental and organizational guidelines for charging and specific regulations regarding 'pass through' item processing.

    EEO/AA/Disability/Veteran

    Responsibilities

    • 1. Maintains and leads the Hospital Chargemaster (pricemaster) development, enhancement and maintenance.
    • 2. Coordinates the compilation of a monthly chargemaster project inventory, including project description, expected outcome, time frames, achievements to date, and expected project valuation.
    • 3. Leads efforts and supports multi-disciplinary groups responsible for monitoring and assuring the accuracy and enhancement of hospital net revenue through management of the hospital pricemaster. Groups may include representatives from various clinical areas, Coding, Medical Records, Billing, Compliance, Information Systems and colleagues from Reimbursement.
    • 4. Ensures accurate establishment of clinical charges, descriptions and billing codes in the chargemaster. Researches and ensures accurate cross-walk of chargemaster details with underlying clinical systems used for charge capture and clinical documentation.Ensures compliance with pricing policy.
    • 5. Maintains and coordinates the establishment of pricing and changes to rates as required.
    • 6. Coordinates reviews to determine charge capture accuracy and comprehensiveness. Reviews include interviews of clinical staff, observance of operational procedures, documentation reviews, validation of data entry and final data capture and other aspects of operational audits. Reviews may be conducted in support of other Chargemaster staff and with assistance from Reimbursement staff, clinical staff, Internal Audit or Compliance staff.
    • 7. Maintains of annual update for Medicare's Ambulatory Payment Categorization (APC) changes required to Chargemaster, billing and coding protocols.
    • 8. Addresses clinical departmental needs on questions, process, status and planned changes or updates to the chargemaster.
    • 9. Researches charge system problems and makes recommendations for resolution. Assists in the development of tools required to understand, monitor and improve charge capture efforts.
    • 10. Maintains the chargemaster consistent with current coding and billing protocols.
    • 11. Communicates routine changes to coding and billing protocols and conventions to affected clinical departments.
    • 12. Works closely with Reimbursement, clinical, Compliance and other Finance colleagues on a number of different chargemaster projects.
    • 13. Maintains financial analysis of gross and net revenue impact of coding and charge capture projects.
    • 14. Works on several projects simultaneously and often leads project efforts with clinical staff.
    • 15. Stays abreast of routine developments in coding and billing regulations.
    • 16. Promotes the Corporate philosophy of positive customer relations.
    • 17. Performs other duties as required.
    • 18. Assures that all procedure, supply and pharmacy charges are accurate based on medical records documentation, encounter forms and clinical charge capture information systems for assigned clinical departments.
    • 19. Leads efforts and supports multi-disciplinary groups responsible for monitoring and assuring the accuracy and improvement of hospital net revenue through management of charge capture, medical records documentation and coding. Groups may include representation from assigned clinical departments, Coding, Medical Records, Billing, Compliance, Information Systems and Reimbursement.
    • 20. Leads efforts to educate clinical staff of assigned departments of importance and necessity of accurate charge capture, coding accuracy and medical record documentation. Creates specific tools to be used by clinicians as reminders, as required.
    • 21. Conducts reviews to monitor and improve charge capture accuracy and comprehensiveness and coding accuracy. Reviews include medical record documentation reviews, interviews of clinical staff, observance of operational procedures and validation of data entry. Feedback from these reviews will be used to educate and train staff.

    Qualifications

    EDUCATION

     

    Bachelor's Degree in business or related clinical discipline, or Licensed RN or Certified Professional Coder (CPC) required.

     

    EXPERIENCE

     

    With a Bachelor's Degree or Licensed RN, a minimum of five years experience in health care finance, billing, coding, direct clinical care, reimbursement, accounting, budget, compliance or insurance. With a CPC - a minimum of eight years of professional work experience in medical coding or closely related field. Proven experience leading and supervising work groups and projects. Experience using personal computer based automated systems, including Windows, Excel and Word is required. Requires strong interpersonal skills with good verbal and written communication skills. Experience with system design and implementation to include policy and procedure development and documentation is preferred. Knowledge and experience in charging, billing, revenue analysis, coding and/or cost accounting preferred.

     

    SPECIAL SKILLS

     

    Knowledge of medical records, CPT coding, billing and medical terminology is required. Demonstrated ability to lead groups and work on numerous projects simultaneously. Ability to influence the thinking of others and deal with all levels of management and different types of staff.

     

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