CHARGEMASTER ANALYST SENIOR in San Diego, CA at Scripps Corporate Offices

Date Posted: 10/16/2018

Job Snapshot

Job Description


At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to work.
 
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates.  So if you’re open to change, go ahead and unlock your potential.
 
Fortune Magazine named Scripps Health among the top employers in the nation on their 21st annual list of the 100 Best Companies to Work For.  Scripps ranked at No. 41 and for the third consecutive year, was the only San Diego-based company to make the list.
 
As Chargemaster Analyst Senior, you will provide assistance and analysis to all levels of clinical management at Scripps in support of suggested, requested and or mandated changes to the Charge Description Master CDM. You will support the development of data analysis and recommendations to minimize negative effects of change. You will work to maintain the Scripps Health facility chargemasters within applicable coding guidelines and Scripps Policies and Procedures, assists with bill problem resolution, and researches and communicates coverage guidelines for billable services.
 
Play an integral role in working with clinical directors and managers to implement and monitor CDM changes. Provide other support to the Manager, Chargemaster as needed. CDM responsibilities include but are not limited to: Monitors and maintains hospital departmental charge masters to ensure coding and billing accuracy of new and existing service codes. Works with clinical directors and managers to implement and monitor CDM changes. Evaluates department requests to insure that all additions, changes and deletions are consistent with proper charging coding practices. Work with clinical directors and managers to insure the appropriate bundling or unbundling of charges so that all charges are submitted to result in appropriate reimbursement while following applicable billing reimbursement regulations.
 
Develop reports to monitor compliance with department recommendations. Assist the Patient Financial Services billing personnel in resolving third party payor billing problems. Works with the Scripps contracting department and third party payors to resolve problems. Participate in the pre contract review process to insure that all billing requirements can be met. Work with Medicare intermediaries and CMS to clarify billing requirements. Document and track all communications and instructions received from government agencies. Communicate this information to all applicable departments. Review Medicare and Medi Cal newletters updates, perform periodic review of the CMS, Medicare fiscal intermediary web sites to keep abreast of pending changes. Work with the Charge Master Steering Committee and affected departments to proactively create plans to adopt and/or implement changes. Review Medicare intermediary, Medi-Cal California Workers Compensation, and other third-party payor bulletins to keep current on billing requirements. Communicates this information to all applicable departments through each facility’s charge master task force/team. Senior Analysis duties include but are not limited to: Initiate, develop and establish facility specific and regional models for financial analyses as related to requested and mandated changes to the charge master.  Develop reports to evaluate the reimbursement effect of third-party payor contract proposals as requested by the facility Fiscal Directors and /or financial analysts.
 
Provide analytical support related to reimbursement and billing to facility Fiscal Directors and/or financial analysts. Develops, implements and monitors the charge master database systems which enable corporate-wide management reporting on financial and operational data. Provide analyses for corporate level reimbursement projects as requested by the facility’s Fiscal Director/ Financial Analyst or PFS Management. Create concise, relevant, accurate financial and statistical data in support of finance projects as requested.

Job Requirements

 Required Education/Experience/Specialized Skills:
  • Five years’ Chargemaster experience for a multi-facility acute care organization and coding certification, CCS, CPC, CPC-H, RHIT, RHIA required, or must be obtained within 12 months of hire; OR Bachelors' Degree (preferred in health-care related field, business, finance or accounting) ; OR Associates Degree or Health Care Professional License (i.e. nursing, radiology, respiratory therapy); OR five years procedural coding for Medicare, Medi-Cal and California Workers Compensation in an acute care setting.
  • Advanced working knowledge of Epic, MicroSoft Office Programs (Word, Excel, Access, Powerpoint), and other software for researching issues concerning CDM maintenance.
  • Knowledge of HCPCS coding and revenue coding required.
  • Demonstrated knowledge of medical terminology.
  • Personal characteristics of success in this function include:  Proven ability to engineer and initiate change.
  • Demonstrates experience in working with large database, particularly extracting and manipulating specific files.
  • Expertise of HCPCS coding and revenue coding with an ability to interpret and apply Medicare and Medi-Cal and other third-party payor billing regulations. Demonstrates exceptional analytical skills.
  • Must be able to understand complex billing situations that arise with a multi-facility hospital organization that provides a wide range of diagnostic and therapeutic modalities.
  • Must have a thorough understanding of medical terminology and be able to apply this knowledge to a wide range of therapeutic and diagnostic situations.
  • Highly developed interpersonal and communication skills (both written and verbal). Must be able to interact tactfully and effectively with physicians, clinicians, nurses and others both inside and outside of the Scripps Health organization on sensitive and/or complex topics.
  • Ability to prioritize plans and initiates multiple tasks and projects. Must be able to work independently, be a self-starter, and self-motivated.
  • Demonstrated ability to provide leadership in team situations.
  • Demonstrated ability to direct individuals within the Scripps Health facilities in order to achieve departmental objectives.

    Required Certification/Registration:
  • Coding certification CPC, CPC-H (AAPC) or CCS (AHIMA), or must be obtained within 12 months of hire.
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Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based Company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.




Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.