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Revenue Process Chargemaster Analyst

Full Time, 80 Hours Per Pay Period, Day Shifts

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Position Summary:

Responsible for the organization and maintenance of the chargemaster and revenue processes for applicable Covenant Health acute care facilities, long-term care facilities, rehabilitation facilities, and independent diagnostic testing facilities (IDTF). Ensures integrity, accuracy, and standardization of the acute and IDTF chargemaster databases. Possesses and maintains a broad-based understanding of the clinical and business operations across a diverse group of hospital and clinical organizations.

Serves as a liaison and resource related to charging and reimbursement for all clinical departments including Nursing, Materials, Pharmacy, Surgery, and ancillary departments along with support departments such as Finance, Information Technology (IT), Revenue Integrity, Health Information Management (HIM), and the Business Offices. Maintains all organizational and professional ethical standards and demonstrates behaviors in alignment with Covenant Health’s Pledge of Excellence. Works independently under limited supervision with significant latitude for initiative and independent judgment. Requires discipline to simultaneously manage multiple tasks throughout the day. Reports to the Senior Revenue Process Chargemaster Analyst

• Responsible for reviewing, authorizing, and recommending chargemaster changes in all chargemaster systems (i.e., AllScripts/Star, Cerner, Medhost, and Meditech) and communicating concerns with the Senior Revenue Process Chargemaster Analyst.
• Responsible for understanding charge build and design in eCare Pricing Tool including tiering logic, charge processing schedules, and CDM Schedules (bill code, CPT/HCPCS, modifiers, and offsite).
• Responsible for understanding charge build and design in Allscripts/Star, including all general FIM and SIM table fields; this also includes but is not limited to HDE/IDE, NDC, billing units, and lab molecular diagnostic test codes as applicable.
• Responsible for understanding the design for Corepoint Mapping which is a table of all eCare charge departments and locations cross walked to the Allscripts/Star chargemaster by location, patient type/encounter, etc.
• Responsible for understanding the design for Covenant Charge Transformation which is used for automated electronic charging and crediting based on coding and billing rules.
• Responsible for understanding charge build and design in Meditech BAR CDM fields, order entry, replacement charges, etc., to support Cumberland Medical Center.
• Responsible for understanding charge build and design in Medhost CDM fields, order entry, panel charges, etc., to support Claiborne Medical Center.
• Creates and maintains user access and routing of electronic chargemaster tools (i.e., chargemaster build e-forms, nThrive product support, and request tools) used by clinical departments and Finance, IT, Revenue Integrity, Health Information Management, and the Business Offices.
• Maintains a strong understanding of CPT/HCPCS, modifiers, and UB revenue codes to ensure data integrity and compliance with respect to chargemaster item descriptions, CPT/HCPCS codes, modifiers, UB revenue codes, pricing, and mapping of charges to the appropriate revenue departments.
• Performs timely chargemaster reviews (e.g., quarterly and annually) to identify CPT/HCPCS codes, modifiers, or descriptions changes that require updates in the chargemaster and downstream systems.
• Responsible for authorization and timely approval of chargemaster request forms that impact charge data and auditing completed charge build to identify errors.
• Maintains an audit trail of all chargemaster changes (e.g., e-forms, spreadsheets, and nThrive CDM Manager Request Tool).
• Monitors daily chargemaster reports for potential charge build errors and takes steps to correct the chargemaster and any patient accounts impacted. Communicates errors to other departments as needed.
• Assists in maintaining accurate data for CPT/HCPCS and UB code redirects per specific insurance requirements and works with IT and the Business Offices to develop and maintain electronic claim manipulation as required by specific insurances.
• Responsible for analyzing reimbursement data for procedural charges to ensure procedural charges are set with approved pricing methodology and any extenuating circumstances considered and presented for approval.
• Effectively manages tasks and projects using prioritization and time management skills. Documents on department SharePoint site to track tasks, progress, and work load. Communicates concerns to the Senior Revenue Process Chargemaster Analyst or when assistance with prioritization and timelines are needed.
• Responsible for interpretation of CMS notifications and regulations (e.g., quarterly, annually, and interim) including but not limited to the Outpatient Prospective Payment System, Medicare Physician Fee Schedule (includes hospital lab, therapy professional services, and IDTF), Inpatient Prospective Payment System, and Skilled Nursing Facility Prospective Payment System that have a direct impact on chargemaster or charge process and communicating any concerns with the Senior Revenue Process Chargemaster Analyst.
• Maintains strong understanding and knowledge of CMS National Correct Coding Initiatives (NCCI) Policies, Claims Processing Manual, Benefit Policy Manual, Transmittals, Medicare Learning Network (MLN) Materials, National Coverage Determinations (NDC), Local Coverage Determinations (LCD) ,and Coding and Billing Articles.
• Responsible for execution and/or dissemination of CMS regulations and payer specific guidelines as they relate to charging, coding, and billing including working with other departments (e.g., Business Offices or IT) to implement processes to meet requirements.
• Serves as a liaison and resource to clinical departments for charging and reimbursement based on regulatory guidelines. Provides support to departments to resolve claims with coding or billing issues that are a result of department charges or charge processes.
• Responsible for developing and providing education to clinical departments addressing charge processes or inappropriate charge practices as needed.
• Serves as a liaison and resource to Finance, IT, Revenue Integrity, Health Information Management Coding, and the Business Offices for charging and reimbursement issues based on regulatory guidelines; assists with resolution of billing issues or denials that are a result of charges, codes, or charge processes.
• Participates in and represents the Revenue Process department in clinical department team meetings and compliance team meetings. Communicates chargemaster changes or compliance issues with the teams and provides education as needed by requesting time on the meeting agenda. Shares information from the meetings with Chargemaster team during monthly huddles.
• Assists in identifying and researching potential compliance issues related to charging practices within Covenant Health and communicating any issues and concerns with the Senior Revenue Process Chargemaster Analyst and Revenue Process Director in a timely manner.
• Maintains the Chargemaster Error Tracking Log timely with complete follow through; the Chargemaster Error Tracking Log is how chargemaster build errors or inappropriate charge usage are tracked through resolution including account usage review, chargemaster build corrections, patient account charge corrections, or referral to Revenue Integrity.
• Establishes and maintains effective relationships with the acute hospital clinical departments and corporate departments (i.e., Finance, IT, Revenue Integrity, Health Information Management, and the Business Offices). Professionally deals with these departments concerning chargemaster standardization and processes across the system. Ability to work effectively in a team environment on a variety of charge related topics with these departments.
• Establishes and maintains effective relationships with the other members of the Chargemaster team. Seeks opportunities to positively impact overall department culture through participation and volunteering to informally lead and invests positively in team’s attitude and perspective by demonstrating pleasant behavior, encouraging spirit, and team commitment. Ability to work effectively in a team environment on a variety of charge related topics within the Chargemaster team.
• Ability to work effectively on own with minimal oversight and direction to coordinate project planning and decision making and follow issues through resolution.
• Demonstrates initiative in seeking opportunities for professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Demonstrates initiative and growth in personal development and objectives determined annually.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.
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Minimum Education:           

Bachelor’s degree in Nursing, Health Information, Finance, or other healthcare related field or an equivalent in experience.

Minimum Experience:       

Experience with Microsoft Office Suite applications required. Strong knowledge and understanding of Medicare, Medicaid, and third party payer rules and regulations required. Analytical problem solving skills and clarity with written and verbal communication skills demonstrated.

Licensure Requirement:      

None