Revenue Integrity ChargeMaster Manager Resume Example
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REVENUE INTEGRITY CHARGEMASTER MANAGER
Highlights
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Experience
Revenue Integrity ChargeMaster Manager
June 2015 to CurrentUniversity Of Chicago Medical Center
June 2015 to CurrentUniversity Of Chicago Medical Center
- CDM management (Physician or Technical) CDM tool application Coding and billing requirements from third party payers CMS regulatory coding and billing guidelines Implemented charge capture initiative for both Physician and Technical services Experience with charge to payment relationship and patient accounting functions and understanding of health care financing and reimbursement mechanisms Extensive knowledge of a hospital, provider based physician and allied health care CDMs, revenue cycle management, including Patient Accounts and Revenue Departments.
- Acute Care Level I Trauma Hospitals, LTACH, Skilled Nursing Facility, 254 Cost Centers & 74 Professional Cost Centers In depth knowledge of CMS regulations, billing compliance and the various data elements associated with related claim forms.
- Ability to project operational and financial impact and understanding of hospital cost structure, charging practices, interfaces systems impact.
- In depth understanding of medical terminology, billing/reimbursement practices, revenue codes and HIM coding (e.g.
- ICD-10, CPT-4, HCPCS, APC, etc.).
- Computer skills using Microsoft Word, Excel, Access, PowerPoint and the Internet Knowledge of the principles, practices and techniques used in the management of people acquired through education, training and supervisory experience Knowledge of regulatory quality of care standards, including JCAHO, Medicare, DHS, Third Party Payers Superior interpersonal skills essential to communicate effectively with all levels of management including leadership, colleagues and others with varying professional backgrounds Ability to problem solve and initiate actions.
ChargeMaster Analyst
September 2012 to June 2015Catapult Learning
September 2012 to June 2015Catapult Learning
- Built new ChargeMaster for Professional Services for new UTROP Physicians Go live 7/1/2014 Built new ChargeMaster for LTACH Services (New to Organization) Go Live 12/1/2013 Project Lead for upgrade Optimum (Lynx) C-Point System Go Live 11/2013 manage and direct the implementation and interface of ChargeMaster system to new Outpatient Clinic openings Ensure all Bolt on Systems through the Hospital are compatible with the truth system.
- i.e.
- CareStream, Novious, Safe Trace, Lynx, Optimum, Patient Keeper SIS, RIS, & MedHost, Create and review charge reconciliation process throughout the hospital facility Revenue Management Compliance through documentation, tracking, trending and education by Implementing a process Review all CMS, Medicare and Medicaid bulletins, provide updates to departments and make changes as needed to the CDM and facility charge practices to ensure compliance with applicable rules and regulations Provide education to revenue producing department staff Implement requested/mandated CDM changes Effectively defend facility charging and CDM-driven coding practices during charge audits Assist with monitoring departmental charging compliance Prepare/provide input into reports as required by management for process improvement Identify accurate CPT; HCPCS level II and revenue codes for service items Perform inpatient and outpatient review for appropriateness of CDM-driven coding and charging, including business office activities, system function, and charging methodologies Illustrate independent, CDM coding best practices Investigate and document any potential for new program and product development associated with coding, charging and billing for new service lines/services offered Illustrate creative problem solving skills through documentation of process improvement reporting/ internal reporting mechanisms Manage annual price increase and monitor CDM to ensure pricing remains competitive within marketplace Project Leader for new Star McKesson projects i.e.
- Prebill-Edit, Pre-bill Edit Workstation Timely audit reviews Work with the Quality Case Management staff serving as the revenue cycle, financial specialist in PFS Work with HIM, PFS, PA, Nurse Auditors and Case Management to ensure that Rules and Regulations are adhered to.
Project Lead ChargeMaster Analyst Lead Consultant
December 2011 to February 2012Bickford Senior Living
December 2011 to February 2012Bickford Senior Living
- Design and Built ChargeMaster from Scratch Project Leader for new Star McKesson projects i.e.
- Prebill-Edit, Pre-bill Edit Workstation Create and review charge reconciliation process throughout the hospital facility Review all CMS, Medicare and Medicaid bulletins, provide updates to departments and make changes as needed to the CDM and facility charge practices to ensure compliance with applicable rules and regulations Provide education to revenue producing department staff Implement requested/mandated CDM changes Effectively defend facility charging and CDM-driven coding practices during charge audits Assist with monitoring departmental charging compliance Prepare/provide input into reports as required by management for process improvement Identify accurate CPT HCPCS level II and revenue codes for service items Perform inpatient and outpatient review for appropriateness of CDM-driven coding and charging, including business office activities, system function, and charging methodologies Illustrate independent, CDM coding best practices Investigate and document any potential for new program and product development associated with coding, charging and billing for new service lines/services offered Illustrate creative problem solving skills through documentation of process improvement reporting/ internal reporting mechanisms Lead annual price increase and monitor CDM to ensure pricing remains competitive within marketplace.
Revenue Integrity ChargeMaster Manager
January 2010 to December 2011Fedex Cross Border － Darien , MT
January 2010 to December 2011Fedex Cross Border － Darien , MT
- Create and review charge reconciliation process throughout the hospital facility Revenue Management Compliance through documentation, tracking, trending and education by Implementing a process Review all CMS, Medicare and Medicaid bulletins, provide updates to departments and make changes as needed to the CDM and facility charge practices to ensure compliance with applicable rules and regulations Provide education to revenue producing department staff Implement requested/mandated CDM changes Effectively defend facility charging and CDM-driven coding practices during charge audits Assist with monitoring departmental charging compliance Prepare/provide input into reports as required by management for process improvement Identify accurate CPT; HCPCS level II and revenue codes for service items Perform inpatient and outpatient review for appropriateness of CDM-driven coding and charging, including business office activities, system function, and charging methodologies Illustrate independent, CDM coding best practices Investigate and document any potential for new program and product development associated with coding, charging and billing for new service lines/services offered Illustrate creative problem solving skills through documentation of process improvement reporting/ internal reporting mechanisms Lead annual price increase and monitor CDM to ensure pricing remains competitive within marketplace Project Leader for new Star McKesson projects i.e.
- Prebill-Edit, Pre-bill Edit Workstation Timely audit reviews Work with the Quality Case Management staff serving as the revenue cycle, financial specialist in PFS Work with HIM, PFS, PA, Nurse Auditors and Case Management to ensure that Rules and Regulations are adhered to.
Education Specialist
January 2007 to October 2009Fedex Cross Border
January 2007 to October 2009Fedex Cross Border
- 90 % travel to hospital facilities to educate on wound care Provide assistance with charge master analysis to program directors and appropriate hospital representatives Meet with HIM department to discuss hospital policies and procedures Meet with hospital business departments to discuss bill drop days scrubber and policy and procedure relating to E/M s and procedures being billed on the same day Train wound care staff on how to review and comprehend the aged trial balance Train on establishing a denial process Educate clinicians and other staff at the wound care facility on accurate documentation Query physicians for clarification of procedures and/or missing dictation Train office managers/coordinators and program directors on wound care as it relates to skin substitutes, HBO and other procedures performed at the wound healing facility Update appropriate staff on coding and reimbursement changes and potential impact Coordinate implementation of system-wide programs, policies and procedures to ensure system compliance with applicable federal and state laws and regulations Conduct compliance education for staff Provide training to staff in ICD-9-CM and CPT/HCPCS coding of both technical and professional components Provide training to staff in auditing daily documentation for medical necessity and appropriate coding of all levels of evaluation and management Audit, compile audit findings and make written recommendations for revisions to systems and procedures Provide coding support via telephone, fax and e-mail to employees and client hospitals when required Track local medical review policies for all wound healing centers' fiscal intermediaries and insurance carriers Develop appropriate training materials for orientation and continuing education for physicians and other health care practitioners for documentations, coding and billing inquiries Provide expertise in appealing third party carrier denials.
ChargeMaster Reimbursement Analyst
May 2004 to July 2006Aln Medical Management － Ridgeland , CA
May 2004 to July 2006Aln Medical Management － Ridgeland , CA
- Create and review charge reconciliation process throughout the hospital facility Revenue Management and Compliance through documentation, tracking, trending and education by implementing a process Review all CMS, Medicare and Medicaid bulletins, provide updates to departments and make changes as needed to the CDM and facility charge practices to ensure compliance with applicable rules and regulations Provide education to revenue producing department staff Implement requested/mandated CDM changes Maintain current knowledge on Medicare rules, regulations, policies and procedures Effectively defend facility charging and CDM-driven coding practices during charge audits Assist with monitoring departmental charging compliance Prepare/provide input into reports as required by management for process improvement Identify accurate CPT, HCPCS level II and revenue codes for service items Perform inpatient and outpatient review for appropriateness of CDM-driven coding and charging, Including business office activities, system function, and charging methodologies Illustrate independent, CDM coding best practices Investigate and document any potential for new program and product development associated with coding, charging and billing for new service lines/services offered Illustrate creative problem solving skills through documentation of process improvement reporting/ internal reporting mechanisms Lead annual price increase and monitor CDM to ensure pricing remains competitive within marketplace Project Leader for new Star McKesson projects i.e.
- Prebill-Edit, Pre-bill Edit Workstation Timely audit reviews Work with the Quality Case Management staff serving as the revenue cycle, financial specialist in PFS Work with HIM, PFS, PA, Nurse Auditors and Case Management to ensure that Rules and Regulations are adhered to Miscellaneous duties.
October 2004 to February 2006Bickford Senior Living － Aurora , MI
- Taught physician billing, inpatient & outpatient medical coding, Human Anatomy and Physiology.
Owner
November 1999 to December 2005Prestige Medical Billing － Billings , STATE
November 1999 to December 2005Prestige Medical Billing － Billings , STATE
- Managed physician billing departments Audited claims and documentation Managed Query Process CPT4-coder / ICD.9- CM coding Posted accounts receivables Posted charges Prepared cash, checks, refunds, processed statements to vendors and patients Prepared monthly aging reports, electronically billed Medicare/Medicaid Oversee the maintenance of all physician licenses, CMEs, and other documents required for a physician to practice Monitored monthly A/R receivables.
Owner
October 1998 to December 2005Prestige Medical Billing Company － Irvine , STATE
October 1998 to December 2005Prestige Medical Billing Company － Irvine , STATE
- Managed physician billing departments Audited claims CPT4-coder / ICD.9- CM coding Posted accounts receivables Posted charges Prepared cash, checks, refunds, processed statements to vendors and patients Prepared monthly aging reports, electronically billed Medicare/Medicaid, and.
- Oversee the maintenance of all physician licenses, CMEs, and other documents required for a physician to practice.
Patient Benefit Account Auditor / Lead Worker RMC
January 2003 to May 2004Jackson Memorial Hospital － Los Angeles , STATE
January 2003 to May 2004Jackson Memorial Hospital － Los Angeles , STATE
- Trained and educated physicians and staff on accurate chart documentation Read and interpret Local Coverage Determinations, National Coverage Determinations and other payer regulations and guidelines as related to coverage of services Understand the relationship between documentation and charges and be able to link the charges on the UB04 bill with the documentation in the medical record.
- Develop an understanding of the operations, system processes and procedures used Compile information and/or prepare reports and analyses setting forth results of audits with appropriate recommendations.
- Actively participate in exit conferences, providing clarification and supporting information Provide support to Billing, Collections, and Customer Service to assist with billing issues and patient inquiries.
- Coordinate interaction with various hospital department representatives to gather supporting documentation or clarification of any audit discrepancies Negotiate with third party medical auditors when documentation of supporting charges is unclear, yet process, procedure and methods appear reasonable based on patients' clinical status Obtain and interpret hospital protocols and policies as required.
Medical Billing Manager
November 1998 to August 2003Dan & Hoffman M.D., P.A － Canton , STATE
November 1998 to August 2003Dan & Hoffman M.D., P.A － Canton , STATE
- Directs and supervised employees Monitored Electronic Billing Medicare/Medicaid and Commercial carriers Trained and educated employees with updated information for all insurance companies Oversee the maintenance of all physician licenses, CMEs, and other documents required for a physician to practice Random focused audits and prepared audit reports with articulate findings Monitored assigned billing reports Worked closely with physicians as it relates to documentation Monitored monthly A/R receivables Directs and supervises employees engaged in Center operations.
- Plans and prepares work schedules and assigns employees to specific duties Assists Director with the hiring, training, disciplining and terminating of office personnel Assists in developing and maintaining new policies, procedures and training programs for the Center Prepares and reviews operational reports and schedules to ensure accuracy and efficiency Formulates annual budgets and reviews financials with Center Leadership Team monthly Recommends cost saving methods to improve efficiency of Center Supports Leadership Team to identify problems with service to patients Ensures all certifications are current.
- Participates in work of subordinates to facilitate productivity and customer service or overcome difficult aspects of work Performs other duties as assigned.
November 1999 to March 2003Charles M. Gremillion M.D
- Managed physician billing departments Audited claims and documentation Managed Query Process CPT4-coder / ICD.9- CM coding Posted accounts receivables Posted charges Prepared cash, checks, refunds, processed statements to vendors and patients Prepared monthly aging reports, electronically billed Medicare/Medicaid Oversee the maintenance of all physician licenses, CMEs, and other documents required for a physician to practice Monitored monthly A/R receivables.
Education
AS : HealthCare ManagementAshworth University － City, StateHealthCare Management
BS : Psychology Presently Attending, 2015Psychology Presently Attending
Skills
10 key adding machine, accounting, accounts receivables, Acute Care, Go live 7, Go Live, analytical skills, Anatomy, articulate, audit reports, auditing, trial balance, Billing, budgets, C, Case Management, CMS, interpersonal skills, oral, competitive, conferences, CPT4, CPT, creative problem solving, Cumulus, client, Customer Service, dictation, documentation, Edit, e-mail, fax, filing, financials, financing, Financial, forms, forth, hiring, ICD-10, ICD-9, insurance, Internet
Knowledge, Laser, Leadership, Lynx, Director, Medical billing, medical coding, Medical Coder, Medical Manager, medical terminology, Medisoft, Meditech, Access, Excel, office, PowerPoint, Sharepoint, Microsoft Word, Works, Nursing, personnel, Physiology, policies, pricing, Problem resolution, processes, process improvement, product development, producing, Coding, Project Lead, Project Leader, protocols, Quality, Read, reporting, RIS, Siemens, supervisory experience, telephone, training materials, training programs, Trauma, upgrade, Visio, wound care, written, written communication skills
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Resume Overview
School Attended
- Ashworth University
Job Titles Held:
- Revenue Integrity ChargeMaster Manager
- ChargeMaster Analyst
- Project Lead ChargeMaster Analyst Lead Consultant
- Education Specialist
- ChargeMaster Reimbursement Analyst
- Owner
- Patient Benefit Account Auditor / Lead Worker RMC
- Medical Billing Manager
Degrees
- AS : HealthCare Management
BS : Psychology Presently Attending , 2015
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