Charge Integrity Coordinator - Nuvance Health : Job Details

Nuvance Health is a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital, and Sharon Hospital in Connecticut and Northern Dutchess Hospital, Putnam Hospital Center, and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practice locations including The Heart Center and non-acute care affiliates.

Summary:

Support and maintain the Charge Description Master (CDM) for all Nuvance Health entities including seven hospitals and physician groups across two states. Accuracy and completeness of the CDM and the interface of charges into the system and the linking of charges and services to the clinical build. Support the Charge Integrity team as well as the CDM Analyst. Assist in the development of charge reconciliation reports and support all audit, CDM, revenue and usage activity. Assist in the build of system-wide CDM Tool as well as developing a process with IT to interface all charges and new codes into the billing and medical record system to ensure an accurate and timely Revenue Cycle. Oversee the integrity of the pricing and pricing maintenance in Cerner and audit charges after interfacing in the system in collaboration with the CDM Analyst. Subject matter expert relating to the CDM structure, CPT, HPHCS, revenue codes, industry trends, and deferral, state, and payer regulations and guidelines.

Responsibilities:

* Daily review/analysis of charging errors working with all Nuvance Health departments. Investigate, analyze, and recommend actions and solutions for registration, coding, charge entry, cash collection, posting and balance problems.

* Effectively support the Charge Description Master Maintenance coordination activities including charge additions, CPT/HCPCS code changes, and pricing updates.

* Work with Charge Integrity Auditors and Revenue Cycle to identify, analyze, and resolve CDM-related claim submission issues. Assist in the CEWL and EBEW error resolution. Assist in the implementation and system build of the annual price adjustment.

* Support internal and external auditors by providing access to data, policies, or other requested material. Understand the clinical event which allows charges to trigger and coordinate with ITG to ensure that triggers are built for all CDM codes.

* Participate in testing, validation, and implementation of all system enhancements and upgrades to ensure that functionality, validation, transparency, charge and price accuracy are maintained. Evaluate, develop, and implement computer-based departmental charge processes in collaboration with operating departments and ITG.

* Process CDM additions, deletions, and change requests in all systems including Cerner Millenium to maintain regulatory compliance and meet operational requirements.

* Build exploding codes in Cerner. Ensure providers are attached to service codes at their dept. level to ensure correct billing. Assist in the streamlining of CDM codes across Nuvance Health to reduce charge line items in accordance with the Corporate Strategy.

* Collaborate with clinical departments and Nuvance Health resources to ensure appropriate inpatient, ancillary, clinical and billing modules are aligned with regard to standardized CDM maintenance process, quarterly, and annual CPT/HCPCS updates. Identify clinical workflows which impact design build. Evaluate consistency of data across financial and clinical systems to ensure CDM data is interfaced appropriately and consistent.

* Support for special projects including collection and analysis of revenue and usage claim data for the hospital, physician, and provider groups in preparation for regular changes to charging, transparency regulations, and an assessment of utilization changes for operational leadership.

* Liaison with Charge Integrity, Managed Care, Access Services, Patient Accounting, and Service Lines regarding billing and pricing issues and concerns. Support the Charge Integrity Audit Team by running reports and processing changes. Work closely with the CDM Analyst.

REQUIREMENTS:

* Bachelor Degree, Business Administration, Accounting, Health Care Information Technology, Computer Science or a related area and/or equivalent combination of training and experience

* Experience with large scale, automated patient billing systems, medical terminology, and coding

* Experience with electronic data interchange, claims processing, third-party payer rules, reimbursement practices, and regulatory guidelines

* Experience with revenue cycle information systems or system implementation teams for projects, application development, and/or support

* Experience w/issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring

* Advanced MS Excel Skills

* Technical knowledge of revenue generation sources including CDM, Charge Capture, CDI, Coding

* In-depth knowledge of hospital and physician practices, procedures, and healthcare concepts related to healthcare revenue cycle and its component operations including billing, collections, charge capture, coding compliance, managed care contractual terms, Medicare and Medicaid reimbursements, third-party reimbursements and cash management.

* Strong problem-solving skills

* Ability to work in a fast-paced and changing environment; Excellent ability to manage deadlines

* Strong organizational and written/oral communication skills

* (3) years relevant experience in CDM Management or IT, Patient Accounting experience preferred

* Coding Certification: CPC, COC, CCA, CCS, and RHIT, Preferred

* Clinical experience, preferred

Location: The Summit, 100 Reserve Rd., Danbury, CT/Hybrid after successfully completing 90-day probation

Work Type: Full-Time/40 Hr.

Work Shift: Daytime flexible hours, 7:30AM-4PM, 8AM-4:30PM, 8:30AM-5PM

Exempt: Yes

Grade: S10

Salary Range:

$32 - $50/HR./DOE

Working Conditions:

* Some manual skills/motor coordination & finger dexterity

* Little or no potential for occupational risk

* Sedentary/light effort, may exert up to 10 lbs. force

* Generally pleasant working conditions

EOE including disability/veterans

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-###-#### (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.