Senior Systems Specialist, Chargemaster (Onsite, Hybrid, Remote)

At NorthBay Health, the Senior System Specialist, Chargemaster, is instrumental in ensuring a compliant and accurate Chargemaster across the organization. This role with serve as an expert and liaison between finance, clinical departments, and hospital-based clinics on all CDM matters. You will actively drive and assist compliance by overseeing system data revisions, participating in high-priority CDM projects and meetings, and assisting in the development and delivery of training sessions for system staff. This position directly contributes to optimizing our revenue cycle and upholding critical regulatory standards.

PRIMARY JOB DUTIES

• Manages the chargemaster's long term integrity, including pricing for CPT and HCPC codes. Manages all updates and modifications to the CDM
• Assists with chargemaster configurations across all relevant software applications
• Assists with cross-functional collaboration with hospital departments and IT to develop a strategic roadmap for an optimized and compliant chargemaster across all integrated systems.
• Develops and implements comprehensive policies, procedures, tools and forms to support efficient chargemaster maintenance.
• Assists with implantation of comprehensive policies, procedures, tools and forms to support efficient chargemaster maintenance.
• Assist department with chargemaster compliance, including all auditing and quality assurance activities.
• Assists with cross-functional meetings with key stakeholders including patient financial services, information systems, health information management and clinical departments to proactively analyze error reports, audit findings and regulatory updates.
• Follow up on outstanding issues and tasks, facilitating meeting with relevant hospital department and administrative representatives to implement necessary corrections. Escalates issues to the Manager, Revenue Integrity as appropriate
• Assists with ongoing billing compliance, reviewing billing manuals and regulatory requirements with staff and departments as needed.
• Leads preparation, education, implementation and ongoing monitoring of changes to APC's, DRG's and all payer fee schedules. This includes researching complex reimbursing issues and collaborating directly with department directors to ensure seamless adaptation and compliance.
• Assists with chargemaster compliance initiatives, assist with any investigatory activities and findings that relate to billing chargemaster data.
• Assists with the maintenance of CDM software applications.
• Collaborates with IT and relevant department to optimize the efficiency and functionality of charge services activities interfaces.
• Assists with training on batch charge entry procedure to relevant users.
• Provides regular updates to the Revenue Integrity manager.
• Enhances professional growth and development through educational programs, seminars, etc.
• Performs regular department audits to maximize and ensure the accuracy if charge capture.

Education:

• Bachelor's degree in computer systems, Business, Nursing or 8 years of experience in Revenue Cycle Management required.

Experience:

• Minimum five years of hospital business office experience, or three years of clinical patient care with two years of medical business office experience required.
• Two years of hospital Medicare billing experience strongly preferred.
• Experience with interfaces required.

Skills:

• Strong organizational and meeting facilitation skills.
• Strong project management capabilities.
• Ability to read and interpret regulatory information related to billing of CDM data.
• Proficient in MS office applications, especially Excel, PowerPoint, Word and Access.
• Knowledge of internet and government websites required.

Interpersonal Skills:

• Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence. Ability to communicate effectively in writing for policies, procedures, external communications and internal communications. Ability to work effectively with a variety of personnel with varied backgrounds, education and skills, in a team environment. Ability to effectively manage multiple priorities.

Standards of Performance:

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort:

• Attendance is an essential function of the job.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Minimal; frequent sitting, occasional lifting or moving boxes/supplies, squatting, standing, walking, and occasionally driving a car.

Hours of Work:

• 8 hours per day. Consistent attendance and work at the agreed hours of work is required.

Work Location Requirement:

• This position may be performed onsite or remotely; however, onsite work is preferred based on business needs.
• Preference will be given to qualified candidates who are able to work onsite and are located within a reasonable commuting distance.

Remote Work Eligibility:

• This position is open to candidates located within the continental United States. Due to state-specific employment requirements and workers' compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands.

Basic Skill Requirements:

• The Specialist- Chargemaster is expected to know these skills when hired into this job:
• Ability to communicate clearly and effectively, both in listening, talking and writing.
• Proficiency in use of Microsoft applications including Excel, Access and Word.
• PC literate: this includes accessing bulletin boards or eligibility files, websites, and shared drives and folders on the NorthBay network to utilize/edit forms, on-line reports, etc. This also includes ability to copy and paste from host systems to documents.
• Ability to relate cordially with co-workers, employers, patients, providers and others.
• Knowledge of all key data elements (CPT, HCPCS, Rev Codes) and data flow of all elements within the Charge Master and other related files.
• Knowledge of claims processing and remittance data.
• Knowledge of Medicare regulations.
• Knowledge of APC's and other payment methodologies that drive charge master updates.

The Specialist- Chargemaster will be taught and expected to learn the following within the 90-day introductory period:

• Knowledge of the NorthBay computerized financial and clinical systems as well as CDM applications and charge interfaces.
• Knowledge of NorthBay's departments and programs.
• Knowledge of billing policies and procedures as they relate to the CDM.