1+ months

Senior Charge Description Master Specialist *FTE 1.0, Days*

Providence Health & Services
Irvine, CA 92604
**Providence St. Joseph Health is calling a Senior Charge Description Master Specialist (Full-Time, Days) to our location in Irvine, CA.**
We are seeking a Senior Charge Description Master Specialist who will ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. The Senior CDM Specialist acts as the liaison between the Ministry and the System CDM Department, and researches CDM maintenance requests for adherence to the Health System standard CDM in a timely manner. The Senior CDM Specialist responds to Ministry inquiries regarding Chargemaster issues and is responsible for the training of Ministry staff regarding the CDM Maintenance process, coding updates and charge capture improvement.
The Senior CDM Specialist acts as a resource to other CDM Specialists in the research and resolution of requests in a timely manner; and is responsible for the training and skill development of the Specialists to maximize available tools for chargemaster compliance. The Senior CDM Specialist coordinates the daily CDM maintenance workflow between the Health System and the Ministries and monitors the alignment of the individual ministries to the Health System's standard CDM. The Senior CDM Specialist is responsible for the documentation of all policies and procedures regarding CDM Maintenance and charge process; and is responsible for training Specialists to evaluate department charge processes to improve charge capture and coding compliance. The Senior CDM Specialist also coordinates with Ministry, IS, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge interfaces.
**In this position you will have the following responsibilities:**
+ Responsible for the review and maintenance of the Hospital ministry CDMs, as well as the overall PSJH System Standard CDM, in Meditech and Craneware Toolkit. Responsible for research and assignment of the appropriate CPT/HCPCS codes, revenue codes, modifiers, multipliers, etc. to the PSJH System standard to meet CMS Medicare and Medicaid guidelines and government regulations.
+ Researches differences from the system standard and monitors ongoing hospital ministry compliance to the standard. Routinely analyzes and communicates the status of chargemaster integrity and accuracy to Director. Notifies Director as appropriate when out of compliance or issues arise.
+ Responsible for maximizing and training others on CDM management software and tools (including but not limited to Craneware Toolkit, Craneware Online Tools, Craneware automatic Insights, etc.) Insures that all CDM Specialists are trained on Craneware Toolkit functions including CDM Workflow.
+ Participates in the CDM Workflow process and orchestrates the timely and accurate maintenance of the chargemaster by CDM Specialists and other participants. Ensures CDM Specialist adherence to PSJH System standard baseline and System Guiding Principles. Notifies Director as appropriate when out of compliance or issues arise.
+ Responsible for researching and understanding CMS Medicare/Medicaid coding guidelines, billing rules and, requirements; educates the System CDM team; develops and maintains library of standard training resources and job aides. Responsible for the preparation and presentation of education curriculum for RI/CDM Team relating to chargemaster, charge capture, and billing compliance. Collaborates with RI/CDM Team to develop standard communication for Ministries regarding CMS updates as appropriate.
+ Responsible for the preparation of annual training materials relating to chargemaster, billing compliance and charge capture for Hospital ministry staff. Develops Epic / EMR system training resources for charging departments to ensure they have processes in place to routinely verify the accuracy of charge entry data.
+ Assists the CDM Specialists in the review of hospital ministry service line areas to ensure that the chargemaster accurately reflects the services provided and complies with regulatory criteria for billing compliance.
+ Assists the CDM Manager/Director with the development and implementation of new or improved procedures related to CDM workflow and other chargemaster related processes and procedures.
+ Collaborates with CDM Specialists to respond to recommendations from Corporate Compliance or external auditors. Drafts response to reflect compliance with coding guidelines and billing requirements. Documents CDM Depts responses and communicates to Hospital ministry and Revenue Cycle stakeholders.
+ Responds to account level inquiries from Hospital Business Office or Revenue Cycle departments related to CDM related billing issues or denials. Assists with the resolution of complicated billing or denial issues related to CDM. Collaborates with Manager and other Revenue Cycle team members to assure compliance with coding and billing processes. Tracks CDM related issues and action items for visibility to CDM Manager and RI/CDM Team.
+ Coordinates with Hospital ministry, IS, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge interfaces. Assists IS and/or Hospital ministry site personnel in test plan development and integration testing related to charges.
**Required qualifications for this position include:**
+ Bachelor's degree or an equivalent combination of education and/or work experience.
+ 5 years hospital chargemaster experience, including the use of CDM Maintenance software (e.g. Craneware, nThrive, Vital Ware, etc.), and experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of CPT, HCPCS and ICD10 coding principles.
+ Intermediate level proficiency in MS Windows and Office applications specifically Outlook, Excel, Word, PowerPoint.
+ Knowledge of government and third party payer reimbursement methodology.
+ Valid Drivers license.
+ Must be able to work regular M-F dayshift 8 am-5pm schedule, Pacific Time.
+ Flexibility to attend meetings for Alaska and Mountain Time zones.
+ Flexibility for air/automobile travel
**Preferred qualifications for this position include:**
+ Three years of operational performance improvement and/or project management experience.
+ Knowledge of government and third-party payer reimbursement methodology required.
+ Experience and knowledge of Hospital charging practices
+ Current knowledge of the Revenue cycle and specifically the flow of charges in and across hospital billing systems
+ Courses in Coding, HFMA certificate
+ Healthcare operations experience, particularly in an acute care hospital setting
+ Experience working with Epic.
+ Experience using MS Teams, Zoom, other remote meeting software.
**About the department you will serve.**
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORCs objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
**For information on our comprehensive range of benefits, visit:**
**Our Mission**
As expressions of Gods healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
**About Us**
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
**Schedule:** Full-time
**Shift:** Day
**Job Category:** Billing/Insurance
**Location:** California-Irvine
**Req ID:** 280919


Posted: 2021-03-30 Expires: 2021-05-13

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Senior Charge Description Master Specialist *FTE 1.0, Days*

Providence Health & Services
Irvine, CA 92604

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