Job Description

The Chargemaster Specialist works with cross-functional teams on projects including but not limited to: review, analyze and maintain chargemaster pricing for all clinics; review payer policies for any updates and changes that may impact reimbursement; provide support to chargemaster team; provide support to payment compliance team by researching claim denial issues and root cause problem solving with payers; help develop standard operating processes.

This Chargemaster Specialist will have the following qualifications: excellent oral and written communication skills; strong interpersonal and relationship-building skills; ability to work both independently and as part of a team with professionals at all levels; certified medical coder; proficient in Microsoft Office software applications. Knowledge of healthcare payer contracts, healthcare billing/payment processes, and experience with outpatient physical therapy, occupational therapy and speech therapy is preferred.

ESSENTIAL FUNCTIONS:

• Maintain and update chargemaster pricing and rationale
• Update Medicare expected reimbursement amounts annually
• Review and update State Workers Compensation and Medicaid expected amounts annually
• Review payer policies for updates and changes that may impact reimbursement
• Research claim denial issues and root cause problem solving with payers
• Special projects
• Support Chargemaster team as needed
• Other duties as assigned

KNOWLEDGE AND SKILLS:

• Excellent oral and written communication skills

• Thorough understanding of managed care claim lifecycle

• Strong interpersonal and relationship-building skills

• Ability to work both independently and as part of a team with professionals at all levels

• Proficient in Microsoft Office software applications including but not limited to: advanced Outlook skills, Excel, Pivot Tables, etc.

• Knowledge of healthcare payer contracts, healthcare billing/payment processes

• Knowledge of physical therapy, occupational therapy and speech therapy is preferred

• Ability to manage multiple projects efficiently and accurately

• Demonstrate ability and commitment to excellent customer service to develop and maintain effective working internal & external relationships

• Able to effectively manage conflicting priorities, adapt to ever changing responsibilities and meet highly structured deadlines

• Excellent critical thinking skills, professionalism, reliable judgment, and the ability to communicate in an articulate and sensitive manner with strategic partners, administrators and internal teams

Qualifications

• Bachelor’s degree in Business, Finance, Health Care, or related field preferred, or high school diploma and appropriate combination of education and experience

• Certified Medical Coder (CPC, CCA, CCS, CCS-P)

• Charge master experience

• 5 years of clinical coding experience in health care setting