Employment Type:

　　Full time

　　Shift:

　　Day Shift

　　Description:

　　Responsible for ensuring the integrity of the Charge Description Master (CDM) and the charge capture process by providing sound advice and leadership as it relates to individual procedures charged, CPT codes, billing requirements and compliance issues. Coordinates and implements changes in the CDM in all information systems and facilitates CDM requests with System Office CDM and Compliance team. Ensures CDM codes are compliant with Medicare and local payer guidelines.

　　Works with various clinical departments and physicians throughout the ministry organization to proactively implement changes in the charging process to enhance collection of revenue while meeting and complying with all local, state, federal, and third-party billing requirements. Collaborates with Revenue Integrity colleagues to perform root cause analysis on issues with pre-billing and identifies opportunities for optimization of revenue. May be responsible for local pricing decisions. Required to travel between locations within the Region.

　　As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

　　Your best life. Our one purpose.

　　At MercyOne, we know colleagues benefit from and strengthen our network. You'll find support, teamwork and coworkers that help you get the best out of yourself.

　　What we offer:

　　We care about your well-being, both physical and mental, which is why our benefit package includes:

　　Wellness programs

　　Education reimbursement

　　Personalized health insurance plans including dental and vision

　　Paid time off

　　Long- and short-term leave

　　Retirement planning

　　Life insurance coverage

　　About the job:

　　Responsible for ensuring the integrity of the Charge Description Master (CDM) and the charge capture process by providing sound advice and leadership as it relates to individual procedures charged, CPT codes, billing requirements and compliance issues. Coordinates and implements changes in the CDM in all information systems and facilitates CDM requests with System Office CDM and Compliance team. Ensures CDM codes are compliant with Medicare and local payer guidelines.

　　Works with various clinical departments and physicians throughout the ministry organization to proactively implement changes in the charging process to enhance collection of revenue while meeting and complying with all local, state, federal, and third-party billing requirements. Collaborates with Revenue Integrity colleagues to perform root cause analysis on issues with pre-billing and identifies opportunities for optimization of revenue. May be responsible for local pricing decisions. Required to travel between locations within the Region.

　　As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

　　What you will do:

　　Performs activities related to charge monitoring and follow-up, as well as the set-up and maintenance of the Charge Description Master (CDM), and support coverage of other departmental functions. Frequent communications will occur with Physicians, Medical Records/Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance, and Managed Care department staff. Charge Description Master maintenance and charge capture monitoring and resolution responsibilities include, but may not be limited to:

　　Audits Charge Master for each department on a regular basis, including the review of appropriate coding, departmental and pricing concerns, and any other issues deemed appropriate. Conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal guidelines relating to the charge capture and billing of services. Prepares and submits audit findings and makes recommendations to management.

　　Approves and assists in the implementation of charge codes and charge practices, as well as providing input and recommendations as it relates to charges for new services and all service lines. Provides financial analysis and other documentation, as required.

　　Provides guidance, communication and education on correct charge capture, billing, and coding processes, and local, state, and federal guidelines.

　　Coordinates concurrent and retrospective audits of patient medical records and itemized bills, as requested by patient, third party payer, or external auditors.

　　Review's facility bill rejections, edits, and reports findings to Ministry Organization leadership. Analyzes data obtained for evidence of deficiencies in controls, duplication of effort, fraud, or lack of compliance with laws, government regulations. Utilizes this data to assist in the development of CDM and charge capture policies or procedures.

　　Examines, reports, and makes recommendations regarding departmental charge activities for compliance with management plans and policies.

　　Conducts special reviews for management such as those required to discover mechanics of detected fraud and to develop controls for fraud prevention.

　　Works with Information Systems and other departments to ensure that the appropriate Charge Description Master (CDM) and other necessary billing data are placed on the claim appropriately, which includes ancillary or clinical systems related to revenue cycle, charge capture and billing

　　Reviews bulletins to maintain an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.

　　Attends coding and reimbursement workshops and webinars; communicates related information to appropriate departments and ensures understanding and assists with applicable process or system changes.

　　Coordinate's pricing increases as directed by Finance and utilizes strategic pricing applications to maximize payments within the hospital budget requirements.

　　Other duties as assigned.

　　Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

　　Prepares special reports and analysis as directed by leadership. Participates and leads in committees and meetings. Serves as liaison to Payer Strategies and System Office CDM and Compliance to fully understand local contracts and ensure CDM alignment.

　　Ascertains through the systematic audits of the charge procedure dictionary, compliance issues (bundling and/or unbundling of charges) and makes appropriate recommendations to ensure compliance with regulatory mandates.

　　What we are looking for:

　　Must possess a demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-9, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a bachelor’s degree in healthcare or business Administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education and experience.

　　Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities. Experience with CDM oversight strongly preferred.

　　Proficiency with MS Excel, Access, Business Objects highly desired and strong level of competency with Word and PowerPoint.

　　Working knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) is strongly preferred.

　　Excellent verbal and written communication and organizational abilities. Strong interpersonal skills are necessary in dealing with internal and external customers. Comfortable leading meetings and process improvement initiatives. Accuracy, attentiveness to detail and time management skills are required.

　　Ability to work independently, and to prioritize and manage multiple functions and priorities simultaneously.

　　Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

　　Must be comfortable operating in a collaborative, shared leadership environment.

　　Why MercyOne Western Iowa?

　　MercyOne Western Iowa serves the needs of individuals in a 33-county area including western Iowa, eastern Nebraska and southeastern South Dakota. MercyOne Siouxland Medical Center, a 238-bed regional facility, is home to the only Level II trauma center in the area – one of only four trauma care facilities in the state to receive verification from the American College of Surgeons – and MercyOne Air Med, a regional helicopter ambulance service. Along with owned and managed hospitals in Primghar and Hawarden, Iowa, and a partnership with Dunes Surgical Hospital in South Dakota, the region also operates a primary care network, specialty care clinics and home health care, providing an entire continuum of preventative, primary, acute and tertiary health care services to provide personalized, compassionate care for the communities we serve and beyond.

　　About MercyOne and Trinity Health

　　We are MercyOne: a connected system of health care facilities and services dedicated to helping you and your community live your best life so you can get well—and stay well. With 420 care locations, our clinics, medical centers and affiliates are never too far from home, allowing us to improve the lives of individuals and communities across the state of Iowa and beyond. MercyOne Western Iowa is a member of Trinity Health

　　Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

　　Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

　　Our Mission:

　　We, Trinity Health, serve together in the spirit of the gospel, as a compassionate and transforming healing presence within our communities.

　　Our Core Values:

　　Reverence

　　Commitment to Those Who are Poor

　　Safety

　　Justice

　　Stewardship

　　Integrity

　　Our Vision:

　　We will be the most trusted health partner for life.Our Actions:

　　As a Trinity Health colleague, I will:

　　Listen to understand.

　　Learn continuously.

　　Keep it simple.

　　Create solutions.

　　Deliver outstanding service.

　　Own and speak up for safety

　　Expect, embrace and initiate change.

　　Demonstrate exceptional teamwork.

　　Trust and assume good intentions.

　　Hold myself and others accountable for results.

　　Communicate directly with respect and honesty.

　　Serve every person with empathy, dignity and compassion.

　　Champion diversity, equity and inclusion.

　　Our Promise:

　　We Listen.

　　We Partner.

　　We Make it Easy.

　　MercyOne Siouxland Medical Center and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

　　Our Commitment to Diversity and Inclusion

　　Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

　　Our Commitment to Diversity and Inclusion

　　Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

　　Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

　　EOE including disability/veteran