Charge Integrity Specialist

2 weeks ago

Franklin, Tennessee, United States Community Health Systems Full time

Overview:

The Charge Integrity Specialist is tasked with the crucial role of evaluating, formulating, and instituting charge protocols and methodologies across the organization to uphold charge accuracy in accordance with CMS and other regulatory bodies.

This role demands a continuous update of knowledge regarding various regulatory agency standards to ensure compliance alongside precise, comprehensive, and timely charge processes.

This position collaborates nationally across the organization, engaging with diverse departments and various systems (e.g., Medhost, Cerner) to guarantee the integrity of charge processes. The specialist is also responsible for auditing existing charge procedures and, when necessary, identifying and rectifying charge processes.

Additionally, this role involves creating training materials for staff to ensure the implementation and maintenance of accurate charge processes.


Key Responsibilities:
Conducts financial chart audits, documenting findings and recommendations along with actionable plans for enhancement. Implements and monitors action plans to ensure adherence to CHS standard charge capture practices.
Supports clinical personnel in updating, executing, and training staff on new charge processes.
Collaborates with vendors to investigate and confirm charge capture opportunities and devise solutions; develops training to enhance charge capture.

Establishes charge reconciliation procedures to ensure all charges are recorded for patients treated in clinical departments; educates clinical staff on the charge capture process and performs audits to verify compliance with charge reconciliation protocols.

Works closely with the CHS charge master team on charging policies and procedures, providing education to facilities, and ensuring appropriate revenue generation by department.

Offers assistance to all facilities regarding charge inquiries, training, education, and charge reconciliation and capture.

Collaborates with CHS divisions on any charge or revenue-related issues or concerns stemming from charge audits, including investigating and resolving root cause problems.

Records and presents findings using Excel spreadsheets or Access databases.
Provides feedback and support during the corrective action process.
Prepares monthly summaries for CHS Leadership.
Submits daily reports of findings, issues, resolutions, etc., for hospital leadership.

Qualifications:

Required Education:
A Bachelor's degree in business, healthcare, or a related field is preferred.
Required Experience: 3 to 5 years of experience in Revenue Cycle and Cerner.

Required License/Registration/Certification:
RHIA, CCS-P, and/or CPC certification.

Physical Requirements:

To effectively perform this role, with or without reasonable accommodation, the following requirements are outlined: The employee must be able to read, review, prepare, and analyze written data and figures using a PC or similar device, necessitating visual acuity.

The employee may occasionally need to climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.

Generally, the employee is not significantly exposed to adverse environmental conditions, and job functions are typically carried out in settings similar to those found in general office or administrative work.

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