Charge Description Chargemaster/Fee
Primary Location Pasadena, California
Worker Location Flexible
Job Number 1336486 Date posted 02/25/2025
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Description:
Job Summary:
Assumes ownership and leadership over Master CDM (Chargemaster) and Fee Schedules maintenance relating to changes in government and commercial payor regulations, coding requirements, and pricing policies. Leads and coordinates all operational areas to improve process for updating and ensuring compliance to CDM. Conducts audits and reviews CDM with operational areas to ensure compliance and identify areas of opportunities for improvement. Serves as consultant to operational areas including physicians and staff on all matters related to CDM, charging and KP pricing policies. Recommends and implements changes to improve charge capture, coding, billing and pricing policies. Works collaboratively with related departments, areas and staff.
Essential Responsibilities:
- Responsible for CDM master file. Ensures appropriate charge codes, procedure codes, rates, and billing codes are maintained in CDM Master. Defines services and assigns charge codes, rates, and billing codes.
- Ensures CDM is updated and compliant with all regulation changes.
- Leads regional team; meets regularly for significant matters relating to improving CDM accuracy and compliance.
- Performs regular reviews/audits of CDM. Ensures CDM meets organizations pricing policy requirements and is compliant, identifies deficiencies, and facilitates or makes changes as necessary to comply with policies and regulations. Identifies services being performed but not charged for or is charged inappropriately with review and discussion with clinical department personnel.
- Assesses requests for new services, develops related charges for billing, identifies impacts to charging/billing processes and facilitates changes.
- Develops and improves organizations pricing policies for all services for CDMs. Formulates pricing strategies for negotiated contracts and capitalization, collaborates with pricing department, and monitors to ensure compliance.
- Educates and serves as resource to departments, physicians, and practitioners on charging and responding to all inquires. Refers to appropriate department as necessary. Trains on proper CDM maintenance procedures.
- Analyzes UB 04 and 1500 billing issues that relate to charges/codes. Facilitates changes to optimize revenues and be compliant; collaborates with appropriate department.
- Establishes and monitors a process with purchasing, coding, billing, and clinical departments to ensure all new supplies have appropriate HCPC codes and related information is attached for CDM purposes.
- Works on special projects that assist the organization in attaining or exceeding revenue cycle and compliance objectives.
Basic Qualifications:
Experience
- Minimum five (5) years of demonstrated experience working with hospital and physician CDMs and Fee Schedules to include analysis and evaluation.
- Minimum two (2) years supervisory/lead or project management experience.
Education
- Bachelors degree in business, finance, or related field OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Knowledge of medical coding.
- Knowledge of Federal and State Medicare/Medicaid laws and Commercial Third Party payor regulations.
- Demonstrated knowledge of and skill in adaptability; change management; conflict resolution; creativity/innovation; decision making; group presentations; group process facilitation; influence; interpersonal relations; oral communication; problem solving; project management; results orientation; systems thinking; team building; teamwork; written communication; organizational skills; time management; initiative; and prioritization.
- Demonstrated knowledge of and skill in the following PC application(s): word processing; spreadsheet; database.
Preferred Qualifications:
- Fee for Service health care industry experience.
- Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA).
Primary Location: California,Pasadena,Walnut Center - Regional Offices
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Po/Ho Corp - Revenue Integrity - 0308
Pay Range: $114500 - $148170 / year
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
