Trinity Health Revenue & CDM Optimization Liaison in Ft. Lauderdale, Florida
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Performs activities that relate to charge monitoring and follow-up, as well as the set-up and maintenance of the Charge Description Master (CDM), and support coverage of other departmental functions. Frequent communications will occur with Physicians, Medical Records/Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance, and Managed Care department staffs. Charge Description Master maintenance and charge capture monitoring and resolution responsibilities include, but may not be limited to:
- Audits Charge Master for each department on a regular basis, including the review of appropriate coding, departmental and pricing concerns, and any other issues deemed appropriate. Conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal guidelines relating to the charge capture and billing of services. Prepares and submits audit findings and makes recommendations to management;
- Approves and assists in the implementation of charge codes and charge practices, as well as providing input and recommendations as it relates to charges for new services and all service lines. Provides financial analysis and other documentation, as required;
- Provides guidance, communication and education on correct charge capture, billing, and coding processes, and local, state and federal guidelines;
- Coordinates concurrent and retrospective audits of patient medical records and itemized bills, as requested by patient, third party payer, or external auditors;
- Reviews facility bill rejections, edits and reports findings to Ministry Organization leadership. Analyzes data obtained for evidence of deficiencies in controls, duplication of effort, fraud, or lack of compliance with laws, government regulations. Utilizes this data to assist in the development of CDM and charge capture policies or procedures;
- Examines, reports, and makes recommendations regarding departmental charge activities for compliance with management plans and policies;
- Conducts special reviews for management such as those required to discover mechanics of detected fraud and to develop controls for fraud prevention;
- Works with Information Systems and other departments to ensure that the appropriate Charge Description Master (CDM) and other necessary billing data are placed on the claim appropriately, which includes ancillary or clinical systems related to revenue cycle, charge capture and billing, and
- Reviews bulletins to maintain an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.
Prepares special reports and analysis as directed by leadership. Participates and leads in committees and meetings. Serves as liaison to Payer Strategies and System Office CDM and Compliance to fully understand local contracts and ensure CDM alignment.
Ascertains through the systematic audits of the charge procedure dictionary, compliance issues (bundling and/or unbundling of charges) and makes appropriate recommendations to ensure compliance with regulatory mandates.
Attends coding and reimbursement workshops and webinars; communicates related information to appropriate departments and ensures understanding and assists with applicable process or system changes.
Coordinates pricing increases as directed by Finance and utilizes strategic pricing applications to maximize payments within the hospital budget requirements.
Other duties as assigned.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Must possess a demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-9, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing or a related fields, or an equivalent combination of years of education and experience.
Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities. Experience with CDM oversight strongly preferred.
Proficiency with MS Excel, Access, Business Objects highly desired and strong level of competency with Word and PowerPoint.
Working knowledge of third party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) is strongly preferred.
Excellent verbal and written communication and organizational abilities. Strong interpersonal skills are necessary in dealing with internal and external customers. Comfortable leading meetings and process improvement initiatives. Accuracy, attentiveness to detail and time management skills are required. .
Ability to work independently, and to prioritize and manage multiple functions and priorities simultaneously.
Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Job Number: 00176076
Location: Ft. Lauderdale, FL
Organization Name: Holy Cross Hospital
Facility: HCHFL - Holy Cross Hospital
Employment Type: Full time