• Work with internal and external partners to identify and validate new provider concepts and scenarios through analysis of paid claims data, review of internal payment and medical policies, and any other pertinent information to support determination(s). • Independently evaluate and analyze submitted claims to ensure the concepts/scenarios aligns with Capital book of business. • Includes but not limited to: Research and analysis of applicable provider contract terms and rates • Analysis of member benefits and utilization • Analysis of overarching administrative regulations (Federal, State, BCBSA, etc.) • Analysis of appropriate provider coding and billing practices and coding guidelines. • Serve as a department lead for to present new edit concepts and issues to internal business areas. • Communicate status updates verbally and in writing to impacted internal business areas. • Identify new edit or solutions, projects risks, and contingencies. • Conduct root cause analysis and identify process improvement opportunities. • Build strong working relationships with internal and external customers. • Summarize verbally and in writing, advanced analytical research, including claim analysis, which is understandable to the intended audience. • Facilitate meetings including preparing agendas, minutes, and other documentation as needed. • Communicate delays, risks, and impacts to both management and business areas. • Ongoing business evaluation of vendor updates, but not limited to LCD reviews, and knowledge base updates (edits).

The incumbent for this position is responsible for coordinating the charge master system and function, which is a listing of hospital services and procedures and the charges associated with those procedures. This position will utilize charge master management software and other resources to maintain a complete, accurate and standardized charge master. This position will provide charge master expertise, support, education, guidance and recommendations to clinical and administrative departments in order to optimize net revenue. Minimum Education Associate's Degree (Required) Bachelor's Degree Healthcare related field or equivalent work experience (Preferred) Minimum Work Experience 3 years 3 - 5 years of experience in charge capture, coding or charge description master in a hospital environment (Required) Functional Accountabilities Department Strategic Planning - Provide education and in-service training to departments. - Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM. - Process CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner. - Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments. - Analyze data within the CDM and assign accurate CPT/HCPCS and revenue codes to the Charge Master to insure compliance with regulatory agencies. - Distribute coding and billing regulatory requirements and/or announcements to all applicable departments. - Responsible to make CDM related decisions that require significant analysis and investigation. - Develop and maintain policies and procedures for the CDM, Pricing Policies and charge capture processes. Program and Service Administration and Implementation - Perform all maintenance to the Charge Description and Service Master and the Room and Bed Master Files - Create and maintain all hospital transaction codes and revenue department codes. - Monitor and report all revenue department's charge volumes and posting lag days. - Research and resolve all charge and service master related code errors that affect the recycle and reject reports. - Assist in performing comprehensive reviews with clinical departments to ensure completeness and accuracy of charge description master. - Take initiative to identify system and/or operational problems and participate in the development of solutions to improve billing functions. Human Resources and Relationship Management - Serve as expert resource for code and processing questions, train and educate coders. - Maintain relationships with, and serve as liaison to department administration, physicians, clinic administration, information services, billing offices, financial offices and other departments. - Participate in team meetings/activities and support the philosophy and goals of the team and department. - Adhere to internal controls and reporting structure. - Remain current with updated coding and billing regulations through yearly continuing education; read all announcements and relevant communications that relate to job duties. - Lead special projects/assignments. Safety - Speak up when team members appear to exhibit unsafe behavior or performance - Continuously validate and verify information needed for decision making or documentation - Stop in the face of uncertainty and takes time to resolve the situation - Demonstrate accurate, clear and timely verbal and written communication - Actively promote safety for patients, families, visitors and co-workers - Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance Organizational Accountabilities Organizational Accountabilities (Staff) Organizational Commitment/Identification - Anticipate and responds to customer needs; follows up until needs are met Teamwork/Communication - Demonstrate collaborative and respectful behavior - Partner with all team members to achieve goals - Receptive to others’ ideas and opinions Performance Improvement/Problem-solving - Contribute to a positive work environment - Demonstrate flexibility and willingness to change - Identify opportunities to improve clinical and administrative processes - Make appropriate decisions, using sound judgment Cost Management/Financial Responsibility - Use resources efficiently - Search for less costly ways of doing things Safety - Speak up when team members appear to exhibit unsafe behavior or performance - Continuously validate and verify information needed for decision making or documentation - Stop in the face of uncertainty and takes time to resolve the situation - Demonstrate accurate, clear and timely verbal and written communication - Actively promote safety for patients, families, visitors and co-workers - Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

The incumbent for this position is responsible for coordinating the charge master system and function, which is a listing of hospital services and procedures and the charges associated with those procedures. This position will utilize charge master management software and other resources to maintain a complete, accurate and standardized charge master. This position will provide charge master expertise, support, education, guidance and recommendations to clinical and administrative departments in order to optimize net revenue. Minimum Education Associate's Degree (Required) Bachelor's Degree Healthcare related field or equivalent work experience (Preferred) Minimum Work Experience 3 years 3 - 5 years of experience in charge capture, coding or charge description master in a hospital environment (Required) Functional Accountabilities Department Strategic Planning - Provide education and in-service training to departments. - Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM. - Process CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner. - Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments. - Analyze data within the CDM and assign accurate CPT/HCPCS and revenue codes to the Charge Master to insure compliance with regulatory agencies. - Distribute coding and billing regulatory requirements and/or announcements to all applicable departments. - Responsible to make CDM related decisions that require significant analysis and investigation. - Develop and maintain policies and procedures for the CDM, Pricing Policies and charge capture processes. Program and Service Administration and Implementation - Perform all maintenance to the Charge Description and Service Master and the Room and Bed Master Files - Create and maintain all hospital transaction codes and revenue department codes. - Monitor and report all revenue department's charge volumes and posting lag days. - Research and resolve all charge and service master related code errors that affect the recycle and reject reports. - Assist in performing comprehensive reviews with clinical departments to ensure completeness and accuracy of charge description master. - Take initiative to identify system and/or operational problems and participate in the development of solutions to improve billing functions. Human Resources and Relationship Management - Serve as expert resource for code and processing questions, train and educate coders. - Maintain relationships with, and serve as liaison to department administration, physicians, clinic administration, information services, billing offices, financial offices and other departments. - Participate in team meetings/activities and support the philosophy and goals of the team and department. - Adhere to internal controls and reporting structure. - Remain current with updated coding and billing regulations through yearly continuing education; read all announcements and relevant communications that relate to job duties. - Lead special projects/assignments. Safety - Speak up when team members appear to exhibit unsafe behavior or performance - Continuously validate and verify information needed for decision making or documentation - Stop in the face of uncertainty and takes time to resolve the situation - Demonstrate accurate, clear and timely verbal and written communication - Actively promote safety for patients, families, visitors and co-workers - Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance Organizational Accountabilities Organizational Accountabilities (Staff) Organizational Commitment/Identification - Anticipate and responds to customer needs; follows up until needs are met Teamwork/Communication - Demonstrate collaborative and respectful behavior - Partner with all team members to achieve goals - Receptive to others’ ideas and opinions Performance Improvement/Problem-solving - Contribute to a positive work environment - Demonstrate flexibility and willingness to change - Identify opportunities to improve clinical and administrative processes - Make appropriate decisions, using sound judgment Cost Management/Financial Responsibility - Use resources efficiently - Search for less costly ways of doing things Safety - Speak up when team members appear to exhibit unsafe behavior or performance - Continuously validate and verify information needed for decision making or documentation - Stop in the face of uncertainty and takes time to resolve the situation - Demonstrate accurate, clear and timely verbal and written communication - Actively promote safety for patients, families, visitors and co-workers - Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

• Support the implementation, deployment and maintenance of technology projects (CRM and CX platforms) • Configure and parameterize tools (surveys, flows, automations, triggers) • Gather requirements, translate business needs into technical requirements and support squads in product evolution • Structure analyses, turn data into actionable insights and generate recommendations to improve processes • Document processes and procedures, ensuring quality and traceability • Work in partnership with technical and business teams, aligning expectations and prioritizing deliverables