Charge Master Coding Analyst

Education:

Degree in HIM, Business Administration or any Medically related field and/or Certified Professional Coder (CPC).

Experience:

5 years minimum hospital experience

3 years’ experience in coding, billing, and/or patient accounting

Knowledge, Skills

& Abilities:

• Knowledge of medical terminology

• Knowledge of coding guidelines

• Investigative ability

• Ability to relate to many levels, such as patients, nurse auditors, and employees throughout all hospital departments.

• Excellent communication and organizational skills.

• Ability to work independently, prioritize tasks and problem-solve.

Licensure / Registration / Certification:

Coding certification, such as CPC (Certified Professional Coder), or Health Information Management Certification such as RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator).

MAJOR JOB DUTIES AND TASKS

Percentage

Of Time:

1.

Annual Auditing

50%

a. Auditing of individual Hospital department charge masters. These tasks are teamed with Charge Master Manager.

b. On schedule or per department request compiles charge master.

c. Reviews with Charge Master Manager all charges and updates, compliance memos, CCI edits.

d. Reviews with nurse manager/coder charging mechanism, makes suggestions for compliance, charge ticket or preference list updates.

e. Reviews and updates CPT, HCPC and ICD-10 codes for individual departments, communicates and educates departments on upcoming changes prior to implementation.

f. Provides summary report on action taken to nurse manager, department coders, Patient Accounting file.

2.

Evaluates information from daily Charge Capture Audit system

10%

a. Reviews monthly bill analyzer report to identify possible missed revenue and coding errors.

b. Works with clinical departments to identify and restore missing charges and builds edits in EPIC to prevent future missed charging.

c. Assists in facilitating conversations with chargemaster groups across all facilities to identify trends and implement system fixes for all hospitals.

d. Maintains vendor relationships with Charge Capture Audit System vendor, including a system support relationship, for troubleshooting, expansion, coding compliance.

3.

Nurse/Department charge Audits

5%

a. Performs defense auditing of targeted medical records in conjunction with the itemized bills for charging errors, sub-standard documentation and inaccurate procedural billing.

b. Obtains medical records and conducts a pre-audit. Resolves as many discrepancies as possible.

c. Memos the account on action taken.

d. Reports audit results to departments along with recommendations for future education and training.

4.

Special Project Management

15%

a. Prepares reports as required by management regarding audit results, process improvement recommendations, systemic billing errors, and documentation concerns.

b. Performs individual account review as requested.

c. Reviews code usage as requested.

d. Provides back up coding support as needed for coders

5.

Maintain Charge Description Master

5%

a. Creates CDMs as requested by departments.

b. Reviews CDM requests for coding compliance.

6.

Billing Clarification Management

15%

a. Reviews Billing Clarification requests from Billing Team.

b. Sends appropriate communication to department contact.

c. Reviews coding related billing denials and provides direction to billing department on how to appeal.