Posted: 09/10/2023

    *This position is on-site*

    Job Summary

    Responsible for the management of Coding and Charge Specialist staff.  The Manager is responsible for the accuracy of ICD-10 CM, ICD-10 PCS, and Outpatient CPT codes for Anderson and Community of Staunton hospitals.  Responsibility includes the education and training of staff members across the Anderson Healthcare system to manage the organization’s chargemaster (ANH, CHS,AMG, CCS, ASC – together “Anderson Healthcare”) and charge capture processes including the accuracy and completeness of medical record documentation, coding and billing throughout the health system. This position acts as the liaison between Revenue Systems and revenue generating departments throughout the Anderson Healthcare system to ensure charging practices and departmental CDM’s are in compliance with the Federal and State billing regulations while simultaneously ensuring appropriate, optimal reimbursement.  Develops processes with department staff and management to facilitate charge capture reconciliation and revenue cycle performance optimization.

    Service and Quality Standards:

    1. Service

    Is Customer focused

                    Anticipates customer needs

                    Adheres to customer service standards

    Is Competent, caring and compassionate

                    Treats coworkers and customers with dignity and respect

                    Demonstrates competent, caring and compassionate behavior

                                    to customers and coworkers

    1. People

    Is conversation conscious

                    Assures confidentiality of patient and employee information

    Is positive in interactions with others

    Is courteous and respectful

                    Promotes a harassment free environment

                    Inspires the trust of others

    Acts in accordance with hospital policies, meets the requirements of the Code of Conduct, and identifies any conflicts of interest.

    1. Quality

    Is excellent in patient care and service

                    Demonstrates multidisciplinary cooperation

                    Assists in obtaining excellent satisfaction scores of feedback

    Is safety conscious

                    Demonstrates safety consciousness and supports safety initatives

    Is involved with improvement efforts

                    Supports performance improvement

                    Seeks ways to improve systems and services

                    Shows commitment to improvement efforts

                    Meets mandatory educational requirements

    1. Growth

    Is a loyal ambassador

                    Demonstrates commitment to hospital mission and vision

    Is active and involved

                    Supports hospital initiatives

                    Champions innovation and supports change

    Is a positive role model

                    Fosters team cooperation

    1. Finance

    Is a good steward of hospital resources

                    Develops/uses efficient work methods

    Is cost effective

                    Conserves organizational resources


    Job Responsibilities:

    1. Works with Anderson Healthcare revenue generating departments to ensure the chargemaster is maintained with compliant and accurate descriptions and CPT/HCPCS codes.  Responsible for implementing chargemaster additions and deletions, and pricing.
    2. Manages Coding Supervisor, Charge Specialists and Coders including: management, payroll, hiring, terminating, staffing, annual evaluations, corrective actions, quality reviews, productivity, auditing and education.
    3. Prepares hospitals for timely implementation of annual and quarterly coding and billing updates and revisions.  Meets with all departments annually to coordinate changes.
    4. Oversees and reviews charging activities of each department to ensure that all charging activities are accounted for in the chargemaster.
    5. Coordinates Charge Specialists work schedules and oversees work load distribution. 
    6. Educates operational departments on charge capture processes throughout the system.
    7. Monitors Coding denials and develops action plan to reduce/eliminate the denials.
    8. Completes medical record and billing audits.  Educates Anderson Hospital staff regarding the accuracy and completeness of medical record documentation, charging, coding and billing.
    9. Researches payer updates (i.e. Medicare, Medicaid etc.), CPT/HCPCS coding, and payer requirements for maximizing reimbursement and maintaining compliance charge capture processes.
    10. Engages with departments to implement process improvement initiatives related to revenue cycle and compliance.
    11. Audits and performs retrospective chart reviews and summarizes key findings and action plan recommendations.  This includes an annual audit of services at risk for compliance and charge capture accuracy.
    12. Collaborates with clinical departments, coding and PFS to analyze denials and claims on hold due to claim edits and provides education to applicable departments. 
    13. Serves as a contact for charge related PFS and coding inquiries and issues.
    14. Coordinates meetings with stakeholders when new service lines have been developed.
    15. Acts as a leader, facilitator or member of project teams relative to changes (i.e. new payer requirements) impacting the chargemaster and/or billing processes.
    16. Develops and presents educational materials for department management regarding chargemaster updates, charge reconciliation, payer requirements, reimbursement, etc.
    17. Maintains excellent communication/feedback with other departments (i.e. HIM, ED, nursing floors)
    18. Resolves edits or errors identified in applicable work queues pertaining to chargemaster and/or coding.
    19. Keeps Director of Revenue Systems informed of system malfunctions, problem areas, delays and other information integral to optimal revenue cycle performance
    20. Performs special projects, such as complex billing investigations, Chargemaster analysis, etc.
    21. Supervises Denials and Appeals Coding Specialist and coordinates training, education (i.e. newsletters and support references), performance audits and assists with annual evaluations and hiring of staff.
    22. Coordinates Denials and Appeals Coding Specialist work schedules and oversees work load distribution. 
    23. Maintains policies/procedures for all areas of responsibility




    Education Requirements and Other Requirements:

    Education Level:  Bachelors’ degree preferred

        Certification/Licensure: Coding Certification required (RHIT, RHIA, CCS, etc.)

    Experience Requirements: Hospital Auditing experience 5 + years.  Knowledge and experience with CPT/HCPCS coding, CMS and third party payor billing rules and regulations. Understanding of managed care requirements.
    Working Conditions:   Exposure Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.  The normal work routine involves no exposure to blood, body fluids or tissues.  Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical or first aid.

    Physical Activity:

                                                                                                               NA          0-25%    26-75%     76-100%


    Lift/Carry                                                                                               X            

    Push/Pull                                                                                               X

    Reach Overhead                                                                                                 X

    Climb                                                                                                     X

    Squat/Bend/Kneel                                                                                               X                                                            

    Sit                                                                                                                                           X            

    Stand                                                                                                                     X            

    Walk/Move About                                                                                                                   X


    The most significant duties have been included in this description.  Other duties may be assigned and the hospital has the right to modify this job description as needed to accurately reflect assigned duties.