Under direction, performs administrative support duties by initiating, coordinating, monitoring, reviewing, analyzing and implementing modifications to the Charge Description Master (CDM) for San Joaquin General Hospital; maintains the Hospital CDM to ensure compliance with all pertinent laws, regulations and third-party reimbursement requirements; and does related or other work as required in accordance with Rule 3, Section 3 of the Civil Service Rules.
This is a single-position class assigned to San Joaquin General Hospital. The incumbent provides administrative technical and analytical support by maintaining the Hospital’s Charge Description Master (CDM) and performing other related duties in order to optimize Hospital reimbursement for services. The incumbent ensures that CDM codes and descriptions are accurate, up-to-date, and in compliance with insurance billing and reimbursement requirements; coordinates with other Hospital staff to analyze and implement CDM modifications; and provides training to physicians and other staff regarding the procedures required to submit and document charges. The incumbent also supports various other billing-related activities as assigned.
Maintains all inpatient and outpatient charge description documents to ensure that all items are a direct reflection of chargeable and billable services; initiates, coordinates, monitors, reviews, analyzes and implements requests to add, change or delete CDM items as appropriate; improves efficiency by eliminating duplicate, inactive or non-compliant charges, thus decreasing the potential for an inappropriate charge being utilized.
Researches billing guidelines to maintain CDM compliance with Medicare and Medi-Cal standards; reviews and updates documents concerning procedural and coding changes and initiates action to update the hospital charge description master as necessary; performs data quality reviews on individual department charge descriptions to ensure compliance with all payer mandates and reporting requirements.
Performs CDM quality control and troubleshooting activities; performs systematic reviews of system-generated reports to monitor charging practices and identifies potential problems; recommends workflow and other process changes to address charging problems or deficiencies; audits health care provider progress notes to ensure that appropriate charges are being reported on patient billing documents; researches and resolves complex billing issues involving rejected charges; analyzes file data for evidence of deficiencies in controls, duplication, fraud, process breakdowns, or compliance.
Provides education, training and guidance to revenue producing departments, as well as physicians and other staff, regarding coding and charging practices, protocols, and documentation requirements; responds to questions pertaining to new or existing practices and the impact on reimbursement; provides basic training on the use of hospital billing system software; oversees and coordinates the provider insurance credentialing process for physicians practicing at San Joaquin General Hospital.
Serves as a liaison to outside physician billing services; runs reports of services provided by outside physicians to determine/calculate (payroll) pay rates.
Maintains and/or modifies departmental charge documents to reflect current CDM choices.
Researches industry trends regarding pricing policies and recommends adjustments to pricing strategies and policies; confers with Hospital management to analyze CDM billing processes, to identify root causes of denials/underpayments, and to analyze new third-party payment requirements.
Implements price changes authorized by the County Board of Supervisors.
Implements CDM data entry or upload maintenance requests; works with information systems staff to ensure that the appropriate CDM information is properly loaded and placed on the claims.
Coordinates and/or oversees projects and processes as assigned; prepares reports, studies, analyses, and other documents as assigned; presents findings to individuals and/or groups as required.
May supervise subordinate staff as assigned.
Education: Graduation from an accredited four year college or university with major course work in public or business administration, healthcare management, nursing, health information management, accounting, finance, or a closely related field.
Experience: Two years of financial or medical billing experience in an acute-care hospital or health care facility that required knowledge of medical charging practices, billing codes and third-party reimbursement requirements.
Substitution: Additional qualifying experience may be substituted for the required education on a year-for-year basis to a maximum of four years.
Standard hospital revenue cycle activities and practices; medical billing compliance issues and their impact on hospital reimbursement; state and federal regulations and procedures that impact the maintenance of a hospital charge description master; typical hospital charge development processes; various coding systems used in healthcare billing; the rules and regulations of Medicare, Medi-Cal, commercial insurance and other programs that provide reimbursement for health care services; methods of performing data analysis for the purpose of regulatory monitoring and reporting; principles, practices, methods, and techniques of public administration and management; techniques of gathering, organizing and presenting data; basic principles and practices in the maintenance of a hospital’s charge description master; computerized healthcare billing system hardware and software; the principles and practices of supervision and personnel management.
Maintain centralized control over a hospital CDM; analyze and implement CDM changes; read and interpret regulatory changes pertaining to third party reimbursement and compliance requirements; research and analyze both narrative and statistical data; prepare analytical reports and other documents; present data in charts, graphs and other appropriate forms; effectively utilize a personal computer to retrieve and maintain information and to prepare documents; communicate effectively, both orally and in writing; establish and maintain effective working relationships with those contacted during the course of the work.
Mobility-Frequent operation of a data entry device; frequent sitting, standing, and walking for long periods; occasional driving, climbing stairs, pushing, pulling, bending, and squatting; Lifting-Ability to occasionally lift up to 15 pounds; Vision-Constant reading and close-up work and good overall vision; frequent eye/hand coordination; occasional color/depth perception and peripheral vision; Dexterity-Frequent holding, grasping and writing; occasional reaching and repetitive motion; Hearing/Talking-Constant hearing normal speech, talking in person and on the telephone; occasional hearing faint sounds; Emotional/Psychological-Constant decision making and concentration; occasional public contact, working alone and exposure to trauma, grief and death; Special Requirements-May require occasionally working weekends, nights and/or overtime; Environmental-Occasional exposure to noise, emergency situations.