Sr Reimbursement Analyst

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Job Summary:

With limited supervisions the Sr. Reimbursement Analyst will formulate and maintain the hospital's Charge Master for assigned areas in order to optimize revenue generation, maintain compliance with third party payers, and create reports relative to charge related topics/trends. Associated functions may include cost management, cost accounting, cost reporting, and decision support and working with cross-functional teams to include but not limited to IT, Patient Accounts, Compliance, and revenue-producing departments in order to provide assurance that revenue is optimized and captured in accordance with best practice.

Core Responsibilities and Essential Functions:

Chargemaster Maintenance and Optimization * Formulate and maintain the hospitals Charge Master for assigned areas and serves as subject matter expert * Coordinates, monitors and approves all changes made to the Chargemaster for assigned areas * Processes CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner * Responsible for manually maintaining all CDM requests for code additions, revisions, and deletions * Analyzes data within the CDM and assigns accurate CPT/HCPCS and revenue codes to Charge Description Master to insure compliance with regulatory agencies * Monitors and ensures quality for all CDM elements not to be limited to status indicator, HCPCS and revenue code compatibility, including descriptions, coding, additions, deletions, pricing, etc. * Conducts quarterly review of assigned charge masters and applies updates as appropriate to enhance revenue for the hospital departments * Adheres to departmental policies and procedures related to charging and charge capture practices * Presents all charge related matters to coordinator and/or manager with recommended action plans Research/Analytical Reporting * Pulls daily charge report for assigned areas to review for charge issues and inconsistencies greater than * Create workqueue management report for assigned workqueues. Identify aging and high dollar accounts to work * Creates and studies revenue reports and make recommendations relative to charging concerns * Researches all charge master related code errors effecting the revenue cycle and reject reports * Distributes coding and billing regulatory requirements and/or announcements to all applicable departments * Research and recommend new charges and changes while analyzing financial impact of suggested changes Claims/Coding * Reviews and studies all information from third-party payers relative to claims filing, coding, and the adjudication process * Serve as expert resource for hard coded CPT/HCPCSs as well as accurately coding and billing charges when needed * Remain current with updated coding and billing regulations through yearly continuing education * Researching all current and future complex Medicare requirements for maximum reimbursement and billing compliance guidelines through all available resources such as CMS, Craneware and Ingenix * Monitors account, charge review and claim edit WQs to reduce time accounts are held up in the billing/claims cycle Resource * Treats clinical, billing and other revenue cycle departments as customers * Educates clinical staff, using power point presentations and webinars, on charging and charge capture related rules and functions * Maintains excellent relationships with, and serve as liaison to, department administration, physicians, clinic administration, information services, billing offices, financial offices and other departments. * Supports clinical staff on charge related software including Epic charge practices and Craneware Online Reference Toolkit * Assists in performing comprehensive reviews with clinical departments to ensure completeness and accuracy of charge description master. * Work in conjunction with Internal Audit and Revenue Manager Managers/Directors to obtain resolution of CDM issues * Work with Revenue Manager Managers/Directors to implement charge code and charge structure improvements and changes Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High school diploma Required and Associate's Degree Preferred or Bachelor's Degree Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• American Health Info Mgt Cert-Preferred

Additional License(s) and Certification(s):

Clinical Certification /License or certified Coder by AAPC Upon Hire Preferred

Required Minimum Experience:

Minimum 5 years of relevant revenue cycle healthcare experience in Accounting, Finance, Clinical, Clinical Support Staff (eg; Pharmacy, Lab, Radiology or Materials), Billing or Charge Master Maintenance Required

Required Minimum Skills:

Analytical /Auditing skills, Communications skills, Presentation skills, Critical thinking skills and project organizing skills, Advanced Excel and PowerPoint skills. Ability to effectively manage multiple tasks and priorities within a fast-paced environment. Experience with Charge Master Evaluation Software and previous working knowledge of Epic Resolute Hospital Billing is preferred. Adheres to internal controls and reporting structure.

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