Revenue Integrity Charge Master Analyst

Job Category:

Revenue Cycle

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Revenue Integrity Charge Master Analyst is responsible for assessing, coordinating and managing the charge capture and reconciliation process for designated service area (s) from creation of the charge through and including a clean claim to improve revenue management and ensure the overall integrity of the charge capture process. The Charge Master Analyst will work closely with revenue cycle and department leadership to ensure charge capture is consistent with governmental and non-governmental regulatory requirements. The Charge Master Analyst will ensure that any new services and/or products are appropriately coordinated (with respect to revenue cycle) and ensures that all charges related to the new service and/or an expanding service is identified, reviewed, built within the EMR, CDM, and an appropriate charge generation model is selected

Minimum Job Qualifications

• Licensure or other certifications: Certification in healthcare compliance (HCAA or AAPC's certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS)

• Educational Requirements:

• Minimum Experience: Minimum five (5) years demonstrated administrative skills in Coding, CDM/Charge Master, Finance, or medical records and demonstrated experience working with hospital charging processes. Extensive experience/knowledge in revenue cycle processes. Extensive experience in effective problem-solving skills, project management skills, and conflict resolutions skills

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements: Bachelors Degree from an accredited college or university in Healthcare Administration

• Preferred Experience: Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance. Possesses working knowledge of various payment and coding systems, particularly OPPS, HCPCS and CPT-4 coding schemes. Experience in multi-hospital organizations. Epic Experience

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Ability to interface with all levels of the organization effectively Incorporating regulatory requirements and performing data input and analysis and QA

• Demonstrated ability to interpret, analyze, develop, direct and implement overall expectations as it relates to large scale implementations and projects

• Ability to identify and redesign inefficient workflow and processes

• Excellent written and verbal communication including the ability to resolve conflicts with tact and diplomacy

• Possess strong interpersonal skills to integrate and successfully function with all levels of the organization

• Ability to analyze and interpret situations and information and offer guidance and quality decisions

• Superior analytical and problem-solving skills

• Ability to perform work independently or with minimal supervision

• Excellent analytical skills to perform analysis and provide recommendations on pricing revenues and reimbursement

• Excel and /or Access

• Strong written and verbal communication skills to work directly with all levels of staff and managements, as well as liaison with consultants and system vendors

Essential Tasks and Responsibilities

• Maintains a charge description master file that is compliant with required governmental laws, regulations, contractual requirements, standards and practices.

• Conducts routine charge capture audits and implements any suggested changes. 

• Interacts with clinical/ancillary departments to ensure that charge codes accurately reflect services provided including, but not limited to, leading the reviews and maintenance of the Hospital and Physician Charge Master.

• Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, fraud alerts, OIG advisory opinions and other relevant publications. Coordinates communication with the Director of Revenue Integrity regarding regulatory or payor changes to impacted leaders.

• Investigates and advises on matters relating to professional/technical billing, coding, or regulatory requirements for documenting, coding, and billing.

• Assess auditing and monitoring trends and coordinate mitigation activities when opportunities for improvement (audit variances) are identified.

• Researches third party payer regulations and ensures timely and accurate compliance with federal, state, and local payer regulations, as well as hospital contracts specific to items charged, coding, bundling, and unbundling.

• Participates on Committees as assigned by management.

• Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities and activities may change at any time with or without notice.

Physical Demands

• Weight Lifted: Up to 20lbs, Occasionally 0-30%

• Weight Carried: Up to 20lbs, Occasionally 0-30%

• Vision: Moderate, Frequently 31-65%

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Occasionally 0-30%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.