CLINICAL CHARGE CAPTURE SPECIALIST
Responsible for supporting hospital charge capture and revenue improvement. Ensures accurate and timely charge capture based on medical record documentation for clinical departments as assigned. Scope of activities include accurate establishment of clinical charge capture, researching and resolving charge system problems and analysis of current systems for purposes of identifying system improvements. Documents system performance, to ensure accuracy, compliance and to improve revenue. Works as part of a multi-disciplinary team that includes clinical leadership and staff, charge entry, medical records, coding, billing, information systems and compliance. Leads projects for the team. Trains staff responsible for charge capture, medical record documentation and collaborates with other departments in the development of improved systems. Supports and enhances the compliance effort of the Hospital and the System by adhering to all regulatory, departmental and organizational guidelines for charging and specific government regulations.
- 1. Assures that all procedure, supply and pharmacy charges are accurate based on medical record documentation , encounter forms and clinical charge capture information systems for assigned clinical departments.
- 2. Leads efforts and supports multi-disciplinary groups responsible for monitoring and assuring the accuracy and improvement of hospital net revenue through management of charge capture, medical record documentation and coding. Groups may include representatives from assigned clinical departments, Coding, Medical Records, Billing, Compliance, Information Systems and Reimbursement
- 3. Leads efforts to educate clinical staff of assigned departments of importance and necessity of accurate charge capture, coding accuracy and medical record documentation. Creates specific tools to be used by clinicians as reminders, as required.
- 4. Conducts reviews to monitor and improve charge capture accuracy and comprehensiveness and coding accuracy. Reviews include medical record documentation reviews, interviews of clinical staff, observance of operational procedures and validation of data entry. Feedback from these reviews will be used to educate and train staff.
- 5. Responsible for compilation of a monthly charge capture project inventory, including project description, expected outcome, time frames, achievements to date.
- 6. Implements updates to charge capture protocols for annual CPT/HCPCS coding changes and Medicare's Ambulatory Payment Categorization (APC) changes and re-educates business clerical and clinical staff as needed. Participates in related chargemaster update process for assigned departments.
- 7. Responsible for monitoring Late Charges and developing action plans for assigned clinical departments to decrease late charges.
- 8. Researches charge system problems and makes recommendations for resolution. Assists in the development of tools required to understand, monitor and improve charge capture efforts.
- 9. Reviews Denials for assigned departments and develops action plans to resolve and identify accounts to be re-billed.
- 10. Ensures that all procedures and products are billed appropriately in assigned departments by conducting random audits of patient accounts.
- 11. Represents assigned departments at hospital wide committees such as APC Committee and Denials Committee.
- 12. Communicates routine changes to coding and billing protocols and conventions to assigned clinical departments.
- 13. Works on several projects simultaneously and often leads project efforts with clinical staff.
- 14. Stays abreast of routine developments in coding and billing regulations.
- 15. Supports and enhances the Compliance efforts of the Hospital and the System.
- 16. Supports the efforts to the Systems Business Office in accurate and timely billing and cash collections.
- 17. Promotes the Corporate philosophy of positive customer relations.
- 18. Performs other duties as required.
Bachelor's Degree in business, Nursing or related clinical discipline required. Coding certification preferred.
Minimum of 5 years experience in direct clinical care in addition to experience in billing, coding, reimbursement, health care finance, or compliance. Experience using personal computer based automated systems, including Windows, Excel and Word is required. Requires strong interpersonal skills with good verbal and written communication skills. Experience with system design and implementation to include policy and procedure development and documentation is preferred. Knowledge and experience in charging, billing and/or coding. Excellent Organizational and Training skills are required.
Knowledge of medical records, CPT, HCPCS and ICD-9 coding, billing and medical terminology is required. Demonstrated ability to lead groups and work on numerous projects simultaneously. Ability to influence the thinking of others and deal with all levels of management and different types of staff.
Yale New Haven Health System, through its Yale New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost-effective, advanced patient care characterized by safety and clinical and service quality.
Yale New Haven Health System, in affiliation with Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care.
In all of its work, YNHHS is committed to the communities it has the privilege of serving.