Senior Systems Specialist, Chargemaster (Onsite, Hybrid, Remote)

At Northbay Health, the Senior System Specialist, Chargemaster, is instrumental in ensuring a compliant and accurate Chargemaster across the organization. This role serves as an expert and liaison between Finance, clinical departments, and hospital-based clinics on all CDM matters. The Senior System Specialist actively supports compliance by overseeing system data revisions, participating in high-priority CDM projects and meetings, and assisting in the development and delivery of training sessions for system staff. This position directly contributes to optimizing the revenue cycle and maintaining regulatory compliance.

Primary Job Duties

• Manages the long-term integrity of the Chargemaster, including pricing for CPT and HCPCS codes.
• Manages all updates and modifications to the CDM.
• Assists with Chargemaster configurations across all relevant software applications.
• Collaborates with hospital departments and Information Technology to develop a strategic roadmap for an optimized and compliant Chargemaster across all integrated systems.
• Develops and implements comprehensive policies, procedures, tools, and forms to support efficient Chargemaster maintenance.
• Assists with the implementation of policies, procedures, tools, and forms to support efficient Chargemaster maintenance.
• Assists departments with Chargemaster compliance, including auditing and quality assurance activities.
• Participates in cross-functional meetings with key stakeholders, including Patient Financial Services, Information Systems, Health Information Management, and clinical departments to proactively analyze error reports, audit findings, and regulatory updates.
• Follows up on outstanding issues and tasks, facilitating meetings with relevant hospital departments and administrative representatives to implement necessary corrections.
• Escalates issues to the Manager, Revenue Integrity, as appropriate.
• Assists with ongoing billing compliance by reviewing billing manuals and regulatory requirements with staff and departments as needed.
• Leads the preparation, education, implementation, and ongoing monitoring of changes to APCs, DRGs, and payer fee schedules.
• Researches complex reimbursement issues and collaborates directly with department directors to ensure seamless adaptation and compliance.
• Assists with Chargemaster compliance initiatives, including investigatory activities and findings related to Chargemaster billing data.
• Assists with the maintenance of CDM software applications.
• Collaborates with Information Technology and relevant departments to optimize the efficiency and functionality of charge service activity interfaces.
• Assists with training users on batch charge entry procedures.
• Provides regular updates to the Revenue Integrity Manager.
• Enhances professional growth and development through educational programs, seminars, and other learning opportunities.
• Performs regular department audits to maximize and ensure the accuracy of charge capture.

Education

• Bachelor’s degree in Computer Systems, Business, Nursing, or 8 years of experience in Revenue Cycle Management required.

Experience

• Minimum five years of hospital business office experience, or three years of clinical patient care with two years of medical business office experience required.
• Two years of hospital Medicare billing experience strongly preferred.
• Experience with interfaces required.

Skills

• Strong organizational and meeting facilitation skills.
• Strong project management capabilities.
• Ability to read and interpret regulatory information related to billing of CDM data.
• Proficient in Microsoft Office applications, especially Excel, PowerPoint, Word, and Access.
• Knowledge of internet and government websites required.

Interpersonal Skills

• Demonstrates the True North values.
• The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at Northbay Health.
• The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
• Ability to communicate effectively in writing for policies, procedures, external communications, and internal communications.
• Ability to work effectively with a variety of personnel with varied backgrounds, education, and skills in a team environment.
• Ability to effectively manage multiple priorities.

Standards of Performance

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

• Attendance is an essential function of the job.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Minimal physical effort required; frequent sitting, occasional lifting or moving of boxes and supplies, squatting, standing, walking, and occasional driving.

Hours of Work

• 8 hours per day.
• Consistent attendance and work during agreed-upon hours is required.

Basic Skill Requirements

• The Specialist - Chargemaster is expected to possess the following skills upon hire:
  • Ability to communicate clearly and effectively through listening, speaking, and writing.
  • Proficiency in Microsoft applications including Excel, Access, and Word.
  • PC literacy, including accessing bulletin boards, eligibility files, websites, shared drives, and folders on the Northbay network to utilize and edit forms, access online reports, and perform related tasks.
  • Ability to copy and paste information between host systems and documents.
  • Ability to interact professionally and courteously with coworkers, employers, patients, providers, and others.
  • Knowledge of key data elements including CPT, HCPCS, Revenue Codes, and the data flow of all elements within the Charge Master and related files.
  • Knowledge of claims processing and remittance data.
  • Knowledge of Medicare regulations.
  • Knowledge of APCs and other payment methodologies that drive Charge Master updates.

The Specialist - Chargemaster will be taught and expected to learn the following within the 90-day introductory period:

• Knowledge of Northbay’s computerized financial and clinical systems, as well as CDM applications and charge interfaces.
• Knowledge of Northbay’s departments and programs.
• Knowledge of billing policies and procedures as they relate to the CDM.

Work Location Requirement

This position may be performed onsite or remotely; however, onsite work is preferred based on business needs. Preference will be given to qualified candidates who are able to work onsite and are located within a reasonable commuting distance.

Remote Work Eligibility

This position is open to candidates located within the continental United States. Due to state-specific employment requirements and workers’ compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands.