*This position is on-site*
Job Summary:
Responsible for the management of Coding and Charge Specialist staff. The Manager is responsible for the accuracy of ICD-10 CM, ICD-10 PCS, and Outpatient CPT codes for Anderson and Community of Staunton hospitals. Responsibility includes the education and training of staff members across the Anderson Healthcare system to manage the organization’s chargemaster (ANH, CHS,AMG, CCS, ASC – together “Anderson Healthcare”) and charge capture processes including the accuracy and completeness of medical record documentation, coding and billing throughout the health system. This position acts as the liaison between Revenue Systems and revenue generating departments throughout the Anderson Healthcare system to ensure charging practices and departmental CDM’s are in compliance with the Federal and State billing regulations while simultaneously ensuring appropriate, optimal reimbursement. Develops processes with department staff and management to facilitate charge capture reconciliation and revenue cycle performance optimization.
Service and Quality Standards:
- Service
Is Customer focused
Anticipates customer needs
Adheres to customer service standards
Is Competent, caring and compassionate
Treats coworkers and customers with dignity and respect
Demonstrates competent, caring and compassionate behavior
to customers and coworkers
- People
Is conversation conscious
Assures confidentiality of patient and employee information
Is positive in interactions with others
Is courteous and respectful
Promotes a harassment free environment
Inspires the trust of others
Acts in accordance with hospital policies, meets the requirements of the Code of Conduct, and identifies any conflicts of interest.
- Quality
Is excellent in patient care and service
Demonstrates multidisciplinary cooperation
Assists in obtaining excellent satisfaction scores of feedback
Is safety conscious
Demonstrates safety consciousness and supports safety initatives
Is involved with improvement efforts
Supports performance improvement
Seeks ways to improve systems and services
Shows commitment to improvement efforts
Meets mandatory educational requirements
- Growth
Is a loyal ambassador
Demonstrates commitment to hospital mission and vision
Is active and involved
Supports hospital initiatives
Champions innovation and supports change
Is a positive role model
Fosters team cooperation
- Finance
Is a good steward of hospital resources
Develops/uses efficient work methods
Is cost effective
Conserves organizational resources
Job Responsibilities:
- Oversight of the chargemaster to ensure it is maintained with compliant and accurate descriptions and CPT/HCPCS codes. Responsible for staff implementing chargemaster additions and deletions, and pricing.
- Manages Coding Supervisor, Charge Specialists and Coders including: management, payroll, hiring, terminating, staffing, annual evaluations, corrective actions, quality reviews, productivity, auditing and education.
- Prepares hospitals for timely implementation of annual and quarterly coding and billing updates and revisions. Meets with all departments annually to coordinate changes.
- Oversees and reviews charging activities of each department to ensure that all charging activities are accounted for in the chargemaster.
- Coordinates Charge Specialists work schedules and oversees work load distribution.
- Educates operational departments on charge capture processes throughout the system.
- Monitors Coding denials and develops action plan to reduce/eliminate the denials.
- Completes medical record and billing audits. Educates Anderson Hospital staff regarding the accuracy and completeness of medical record documentation, charging, coding and billing.
- Researches payer updates (i.e. Medicare, Medicaid etc.), CPT/HCPCS coding, and payer requirements for maximizing reimbursement and maintaining compliance charge capture processes.
- Engages with departments to implement process improvement initiatives related to revenue cycle and compliance.
- Audits and performs retrospective chart reviews and summarizes key findings and action plan recommendations. This includes an annual audit of services at risk for compliance and charge capture accuracy.
- Collaborates with clinical departments, coding and PFS to analyze denials and claims on hold due to claim edits and provides education to applicable departments.
- Serves as a contact for charge related PFS and coding inquiries and issues.
- Coordinates meetings with stakeholders when new service lines have been developed.
- Acts as a leader, facilitator or member of project teams relative to changes (i.e. new payer requirements) impacting the chargemaster and/or billing processes.
- Develops and presents educational materials for department management regarding chargemaster updates, charge reconciliation, payer requirements, reimbursement, etc.
- Maintains excellent communication/feedback with other departments (i.e. HIM, ED, nursing floors)
- Resolves edits or errors identified in applicable work queues pertaining to chargemaster and/or coding.
- Keeps Director of Revenue Systems informed of system malfunctions, problem areas, delays and other information integral to optimal revenue cycle performance
- Performs special projects, such as complex billing investigations, Chargemaster analysis, etc.
- Supervises Denials and Appeals Coding Specialist and coordinates training, education (i.e. newsletters and support references), performance audits and assists with annual evaluations and hiring of staff.
- Coordinates Denials and Appeals Coding Specialist work schedules and oversees work load distribution.
- Maintains policies/procedures for all areas of responsibility
