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Job Description Summary:
This position is responsible for the proactive management of the charge masters and fee schedules for OhioHealth hospital operations covering 1000+ departments at all hospitals with patient charges of $15+ billion annually. The incumbent is responsible to ensure that the charge masters are in compliance with rules and regulations for participation in governmental programs, meet the contractual obligations of non-governmental payers, and are reflective of the services delivered by the department. The incumbent is also responsible to implement special projects related to new hospitals, departments, services, and information systems. This position will coordinate and collaborate the above actions with, but not limited to, clinical departments, the Central Business Office, Health Information Management, Information Systems, Managed Care, Corporate Finance & Financial Reporting, and Ethics & Compliance.
Responsibilities And Duties:
1. 30%
Chargemaster Development: Develop and maintain charge description masters for central Ohio operations. Research federal, state, and non-governmental requirements to assign compliant billing codes for each payer. Determine patient prices in accordance with principals of chargemaster standardization, governmental and non-governmental reimbursement methodologies, and with awareness of uninsured or non-covered patients. Ensure that each chargemaster is comprehensive for all department services. 2.
20%
Implementation and Education: Research, comprehend and apply to OhioHealth chargemasters all changes resulting from annual and quarterly federal and state regulatory changes, including those from CMS Centers for Medicare and Medicaid Service s and the American Medical Association. Communicate changes to operations leaders and department resource persons. Provide necessary education or serve as resource person for education by leaders to their associates. In addition to the clinical departments, collaborate the above actions with the Central Business Office, Health Information Management, Information Systems, Managed Care, and Financial Reporting as necessary. 3.
15%
Consultation: Serve as resource person to campus leaders for research on new technology, alternate reimbursement methodologies, and non-hospital settings. Usually requires incumbent to conduct primary research about services or settings not currently offered in care sites. Findings frequently used by campus leaders in pro-forma or CARF development for new business or capital purchases. 4.
15%
Charge Audits: Audit medical documentation for accuracy and appropriateness of facility billing based on Medicare/Medicaid guidelines, validating that supporting documentation exists to confirm accurate billing. Completes audits for Legal, Risk Management, Managed Care, and Revenue Cycle. 5.
10%
Special projects: Assist manager and director with special projects which are typically non-routine in nature, and are completed in addition to routine responsibilities 6.
10%
Reports potential compliance concerns immediately: Present all available information to leaders describing the nature, magnitude, and timeframe of the situation. Participate as requested on teams with operations, compliance, and other finance departments to review the concern and implement corrective action if required.
As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.
The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time
Minimum Qualifications:
Bachelor's Degree (Required)CPC - CPC Certified Professional Coder - AAPC American Academy of Professional Coders, CPCH - Certified Professional Coder - Hospital - AAPC American Academy of Professional Coders, RHIA - Registered Health Information Administrator - American Health Information Management Association, RN - Registered Nurse - Ohio Board of Nursing
Additional Job Description:
Certification in at least one of the following RN, CPC, CPC-H, CCS, CCS-P, RHIA, or Bachelor's degree in Health Information Management or related field. Knowledge of clinical and financial applications for documentation, billing, coding and patient accounting. 3 - 5 years Experience in Patient Accounts, Health Information Management or Charge Description Master Management. Proficiency in Excel, Access, Reporting and Epic.
Work Shift:
Day
Scheduled Weekly Hours :
40
Department
Charge Analysis
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment