Bethlehem, Pennsylvania
Durham, North Carolina
Nashville, Tennessee
Milwaukee, Wisconsin
Posted: 11-Nov-24
Location: Durham, North Carolina
Salary: Open
Categories:
Internal Number: 250366
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke Health's Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Indiana; Maine; Maryland; Massachusetts; Michigan; Montana; New Hampshire; New Jersey; New York; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; Virginia; or Washington, DC
Remote, M-F Manager, ChargeMaster, and Charging Systems
General Description of the Job Class
Reporting to the Director of Revenue and Documentation Integrity, the Manager for ChargeMaster (CDM) and Charging Systems holds primary responsibility for managing all aspects of CDM and Charging Systems development and maintenance for Duke University Health System (DUHS-Hospital and Professional). Included in these responsibilities is the management of audit, analysis, and verification of charging procedures and charging logic, and ensuring the accuracy of CDM Charge Code build, Charge Router rules, Charging Systems charge review functions, and claims manager activities and optimization.
The position will work collaboratively with key stakeholders as an advisor to clinical and financial management, including DUHS clinical operations staff, finance/revenue management, and revenue/operational managers within the Patient Revenue Management Organization (PRMO); monitoring compliance with Federal and State guidelines; prioritizing and maintaining timely turnaround; serving as a resource when necessary for billing and reimbursement issues; performing periodic audits; providing customer service, including education of CDM and Charging Systems processes; and coordination of activities of CDM, Sr. IT Analysts, and IT Analysts.
Duties and Responsibilities of this Level
Team Management
- Oversees the audit maintenance function to ensure compliance, accuracy, and consistency of the CDM and Charging Systems activities, including all internal control mechanisms
- Continuously evaluates analyst work for potential recommendations around process improvements.
- Undergo appropriate system training and/or identify other training resources to support enhancing CDM and Charging Systems activities; Industry and EPIC certifications demonstrating proficiency
- Supervise CDM Analysts and IT Analysts to manage setting priorities and assist with negotiating/eliminating various barriers to success.
- Provides leadership and direction for departments on Charging Systems and CDM strategies in accordance with state and federal regulatory guidelines, CMS and Medicare Administrative Contractor rules and regulations, Medicaid-specific rules and regulations, and Managed Care contract terms.
Charge Master Management/Maintenance
- Responsible for the development, implementation, and maintenance of the CDM, ensuring accurate CPT/HCPCS and revenue coding.
- Collaborates with the revenue-producing departments to ensure the ongoing coordination and consistency with the CDM and Charge Capture processes, including accurate descriptions, coding, additions, deletions, pricing, revenue code and any other changes.
- Support as needed with data entry, billing/audit questions, facility inquiries, education, database maintenance, statistical analysis and processing of reviews of internal audits
- Lead data analysis, periodic audits and information queries, external audits and special projects. Review results of periodic audits and take appropriate action as indicated.
- Collaborate with DUHS Revenue Management and DUHS Finance to perform applicable analyses to understand budget, gross and net revenue change of proposed CDM changes.
- Partner with internal controls and compliance to design audit processes, policies and procedures.
- Serves as internal resource and expert on CDM issues and reporting.
- Key partner with finance to ensure appropriate assignment of fee schedules.
- Proactively investigate charging practices for appropriateness of charging and margin improvement opportunities, partnering with revenue managers when appropriate.
Charging Systems Management
- Oversee, direct and monitor activities of the charging systems team.
- Provide guidance and support to charge router review and maintenance activities.
- Direct and monitor reporting and analysis of claims manager professional billing rules.
- Stay abreast of and disseminate payer policy changes that require changes, additions or deletions of claims manager rules.
- Direct and/or oversee communication with PRMO, DHIP or Clinical Operation leaders related to charging practices.
- Key thought leader in creatively solving charging logic opportunities.
Payor/Regulatory Compliance
- Maintain a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines.
- Advises and collaborates with the DUHS Compliance Officer, Internal Audit, Regulatory Review and Analysis, legal counsel and outside consultants to analyze, review and assess identified billing, coding, charging and compliance issues.
- Continuously review and update regulations and maintain current knowledge base.
- Interprets government regulations and affects related process changes throughout the system to ensure compliance with these regulations as they relate to the CDM.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Education: | BS Health Information Management, Health Informatics, Health Administration, Finance or Related Field. Master's Degree in Business Administration or Health Administration is preferred |
Experience: | Six years of experience in the healthcare industry is required; two of the six years are supervising or coordinating coding activities. |
Degrees, Licensure, and/or Certification: | Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS), or Certified Professional Coder (CPC). Epic certification or proficiency in CDM preferred but required within 6 months of hire; additional certifications in Epic Resolute preferred; additional proficiency designation in Epic HB or PB Resolute, Charge Router preferred. |
Knowledge, Skills, and Abilities: | Experience working in ChargeMaster as an analyst, familiar with building supply, drugs and procedure charge codes. Broad knowledge of revenue cycle and revenue integrity. Epic certification or proficiency in CDM preferred but required within 6 months of hire; additional proficiency designation in Epic HB or PB Resolute, Charge Router preferred.
Exhibits a customer-service orientation; anticipates, understands, and addresses customer and stakeholder needs promptly. Working knowledge of large revenue cycle systems and metrics.
Extensive knowledge of ICD-10-CM and CPT/HCPCs coding principles and guidelines. Coding certification required: RHIA, RHIT, CCS or CPC. Extensive knowledge of hospital/technical and/or professional services reimbursement systems (IPPS, OPPS, Pass-Through, 340B, DRGs, APCs, RBRVUs and pricing methodologies).
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services, strong managerial leadership and interpersonal skills, excellent written and oral communication skills, excellent analytical skills Ability to problem solve; compile, synthesize, analyze and evaluate complex data and reports to influence solutions. Expert understanding of CMS and insurance regulatory mandates and probes, with ability to implement into system processes via NCD/LCD and bulletin payer reviews.
Must have an expert understanding of the CDM and its relationship to areas such as the General Ledger, Procurement-Supplies, Cost Accounting, Productivity, Cost Reporting and Budgeting. Ability to establish a productive team-based work environment that values the talents and abilities of everyone. Strong team championing, mentoring, coaching, and development skills required. Demonstrated communication and presentation skills.
Knowledge of clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology. Ability to research complex payer, coding and regulatory requirements.
Possess and apply knowledge of healthcare clinical and administrative systems and processes to achieve organizational priorities. Has solid knowledge and proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook. Knowledge of Epic, Power Automate and Power BI is a plus. |
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.