Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

Overview

POSITION SUMMARY

The primary responsibility of the Charge Description Master Technician (CDMT) is the Hospital and Ambulatory Clinics chargemaster maintenance. The charge master maintenance is a continuous process that ensures all services are accurately charged and that the hospital and ambulatory clinics are compliant with government regulations for pricing and provides assurance that the organization receives accurate reimbursement. The CDMT must work with service area leaders and providers along with the Coding Supervisor to assure correct service item service code selection and charging of services. The CDMT must have mathematical skills and apply the appropriate pricing policy to each of the hospital and ambulatory clinic service items. Responsibilities will also include coordination of Charge Description Master tasks with the Revenue Integrity Coordinator for the purpose of two-way communication to the Clinical Service Leaders. The CDMT will provide assistance to the Director of Revenue and Reimbursement as applicable.

Qualifications

NECESSARY QUALIFICATIONS

Education:

Must have High School Diploma or GED

Experience:

• Minimum two-year experience in financial or clinical service areas.
• Minimum one-year experience as a patient access specialist, client service technician, medical billing, accounts receivable technician in a tribal or non-profit healthcare patient accounting setting, or medical coder. Experience as an LPN or RN may substitute patient access specialist, client service technician, medical billing, accounts receivable, or Medical coder.
• Demonstrated knowledge of ICD-9 and ICD-10, and CPT/HCPCS coding/billing procedures, Uniform Hospital Discharge Data definitions regarding diagnostic and procedural sequencing in order to interpret and resolve problems based on information derived from system monitoring reports and the UB-04, HCFA-1500, and ADA billing forms submitted to the third-party payer
• Computer skills; ability to access and use multiple data systems.

MENTAL AND PHYSICAL EFFORT

The physical and mental 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.

Physical:

The work is primarily sedentary with the following physical requirements; prolonged ability to sit, stand, walk, drive, maintain balance, reach; and, frequent ability to twist. Must have ability to stoop, bend, kneel, crouch occasionally; and pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, calculator, printer, fax, etc. Must have the ability to utilize hands occasionally in simple grasping, firm grasping, and, fine manipulation. Must be able to utilize a keyboard for a prolonged period with repetitive movement of fingers. Position may be exposed to prolonged infectious diseases and possible frequent exposure to chemical agents.

Mental:

Exercise a high degree of judgment and leadership in planning, organizing, staffing, directing, evaluating and business office activities. Work is reviewed for conformance to policies, procedures, and practices relating to business offices practices. The employee must have the ability to organize, set priorities, develop, and implement solutions, motivate employees, and operate the department according to the constraints of The Joint Commission, budget, and regulatory agencies. Ability to interact between all disciplines within the facility is required. Must be able to frequently cope with high levels of stress, make decisions under high pressure, cope with anger/fear/hostility of others in a calm way; and work in areas that are close and crowed. Incumbent must have prolonged ability to concentrate; handle a high degree of flexibility; handle multiple priorities in stressful situation; work alone; demonstrate high degree of patience; and, adapt to shift work.

Responsibilities

ESSENTIAL FUNCTIONS:

Analyzes and verifies charge selection accuracy as performed by the clinical service areas

CDMT much keep abreast of coding and reimbursement changes to ensure the hospital and ambulatory clinics optimize reimbursement and reduce claim denials and charge coding errors that assure the accurate maintenance of the charge description master

Analyzes charges in the Charge Description Master (CDM) for appropriate coding and pricing.

Utilizes resources within TCRHCC including output of charge review consultants and regulatory agencies for correct coding practices and new charges.

Develops and implements training required to educate TCRHCC associates of changes, updates and additions to the CDM. Coordinates training resources to provide training at staff meetings, in-services and more formal training when necessary.

Works with TCRHCC Compliance Officer to analyze, interpret, distribute and communicate regulatory and contractual changes to TCRHCC departments as necessary including but not limited to action(s) required for compliance.

Maintains database to track and monitor regulatory changes.

Maintains records of action(s) required, accountability and compliance.

Proficient with MS Excel and Word software applications.

Develops collaborative relationships with all departments at TCRHCC.

Performs quality monitoring of required action of regulatory changes.

Prepares and analyzes reports on a regular and ad-hoc basis related to denials and underpayments. Works with appropriate staff to resolve CDM and charge-related billing denials.

Reviews charging errors identified by Medical Records and Patient Finance and works with originating departments for resolution.

Ensures that charges are entered in a complete and timely fashion to eliminate late charges.

Seeks automated reporting solutions when available. Prepares reports using spreadsheets and database solutions when necessary. Prepares and implements special reports and projects as assigned by the TCRHCC Revenue Cycle Director.

Organizes In-service sessions to include clinical personnel and outside agencies when necessary. Assesses needs for training materials and ensures availability of appropriate materials and resources.

Ensures regular meetings are conducted with PFS staff to provide In-service training on relevant issues as well as departmental and TCRHCC information. Notifies employees throughout TCRHCC of CDM process and system changes or updates.

Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.

Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)

Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction.

Performs other duties and special projects as assigned or required.