Employment Type : Full-Time
Primary City/State: Department Name: Work Shift: Job Category: Primary Location Salary Range: In accordance with Colorado’s EPEWA Equal Pay Transparency Rules. A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today. CDM Services is responsible for the oversight and maintenance of all Banner hospital and clinic charge masters. Within CDM Services, one Lead CDM Consultant and seven CDM Consultants report to the Director of CDM Services. On a daily basis, we work directly with Revenue Integrity, Corporate and Facility Finance teams, as well as service-line CDM gatekeepers in the hospitals. In addition to processing daily maintenance requests, each CDM Consultant manages incoming requests for charging guidance and is typically assigned to at least one CDM project that can cross multiple facilities and service lines. POSITION SUMMARY
This position develops and maintains all patient charges for the organization, as well as identifies, audits, and resolves coding concerns, charging issues, and related operational practices for organizational entities ensuring federal, state, local regulatory and managed care compliance.
CORE FUNCTIONS
1. Implements and maintains all changes, additions, and deletions for any charge description master revision to ensure federal and state compliance and to avoid possible severe penalties and maintain the integrity of the organization’s Enterprise Standard Charge Description Master. Makes recommendations and operationalizes changes as needed. Checks formulas for applicable departments. Completes and implements price changes. Provides information regarding the development of charge description masters for new departments or service lines
2. Conducts internal reviews of the charge description master coding and charging practices. Identifies and resolves any issues. Provides education and training, making decisions and determinations regarding appropriateness of changes. Educates and trains personnel to ensure compliance and avoid fraud and abuse issues. Acts as a resource for corporate compliance. Prepares and operationalizes policies and procedures as identified by external sources.
3. Identifies the departments impacted by the annual CPT-4/HCPCS and UB04 code revisions (additions, deletions, changes, as well as other regulatory language changes). Provides information and recommendations as needed. Ensures timely updates to the charge description masters (coordinating with each applicable department at each facility) to avoid patient account denials.
4. Audits departments’ charge description masters to ensure that all patient charges are included, accurate, and complete. Communicates government payor reimbursement information for related charges to managed care for use in contract negotiations. Completes and submits state rate filing package and any revisions working with facility finance to ensure state compliance. Analyzes overall impact system wide and reports to managed care.
5. May participate in strategic pricing projects to ensure appropriate patient charges while maintaining budgeted revenue. May also assist in analysis of system requirements, validation and maintenance with respect to the charge description master application.
6. This position works with all organizational entities. Requires the ability to work with a variety of personnel throughout the system, external auditors, federal and state government personnel and Medicare Fiscal Intermediary, managed care, contracted payors, CMS and other regulatory agencies. Knowledge of the organization’s data and interfaces are needed for obtaining reliable information.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.
MINIMUM QUALIFICATIONS
Must possess a strong knowledge of business, accounting and/or finance as normally obtained through the completion of a bachelor’s degree in business, accounting, finance or related field.
Must possess a strong knowledge and background in healthcare billing, reimbursement and coding as normally demonstrated through four years of progressively responsible experience in billing, reimbursement and/or coding. Must possess a knowledge of managed care contract and government payor compliance and reporting requirements. Technical knowledge required of CPT-4/HCPCS and UB04 codes.
Excellent organization, oral and written communication skills, as well as ability to maintain highly confidential data.
PREFERRED QUALIFICATIONS
Registered Nurse (RN), Licensed Practical Nurse (LPN) or clinical experience and/or knowledge. Coding certification or an in-depth knowledge of medical coding.
Additional related education and/or experience preferred.