[Hiring] Central Pricing Office Specialist @Ochsner Health

Role Description

This job assumes responsibility for creating and ensuring an environment of price transparency to network physicians and patients. Works closely with the Chargemaster team to learn pricing structure for both Self-Pay and Insurance Based Patients. Answers inquiries from physicians and patients via phone, email or internet regarding pricing issues. Serves as a liaison between Patient Financial Services, Financial Clearance Call Center and customer service operations.

Qualifications

• Required - High School diploma or equivalent
• Preferred - Bachelor's degree in Finance, Accounting, Business, Healthcare Administration or related field

Requirements

• Required - 4 years direct healthcare experience, OR 3 years direct healthcare experience with a Bachelor’s degree, OR 2 years direct healthcare experience with a Master’s degree.
• Preferred - Revenue cycle experience in both Physician Billing and Hospital Billing, Chargemaster or coding experience.
• Preferred - Related professional certification (e.g. CIA, CPA, CISA, CPC, CCS, etc.)

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Must be proficient with Windows-style applications and keyboard and various software packages specific to role.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Working knowledge of medical terminology utilized in medical billing including CPT HCPCS and ICD9 & ICD10.
• Working knowledge of record keeping using an automated system and/or health care billing including Medicaid, Medicare, or other third-party payers.
• Knowledge of hospital payor contracts, denials and payor methodology.
• Working knowledge of public and private sources of assistance and methods of qualifying for funding.
• Working knowledge of medical billing and collection practices.
• Strong interpersonal skills.
• Must have excellent decision-making, delegating, and technical writing skills.
• Established knowledge and skills with Epic is preferred.
• Works with minimal supervision and makes independent decisions.
• Must be able to travel to and from locations across the system.

Job Duties

• Acts as a liaison between the Chargemaster and the physicians/patients.
• Answers patient and physician inquiries addressed to the Central Pricing Office’s phone, email or internet regarding pricing questions and provides accurate estimates.
• Assists with pricing transparency and education to better explain the process and reasoning to physicians and patients through e-mails, phone calls, internet questions, participation in facility and provider meetings and maintenance of the website verbiage and educational material available to patients on pricing and estimates.
• Assists with the establishment of Epic’s Price Estimator Tool and patient estimate work queues as needed by working with the Epic team in establishing rules, creation and modification of estimate templates and self-service options available to patients.
• Identifies additional opportunities to incorporate new services into the estimate and financial clearance workflows.
• Assists leadership and Internal Consultants with special projects and trend analysis to improve estimate accuracy by utilizing the Epic Estimator dashboard to drill into inaccurate estimates and to identify and correct the root cause whether it be technical or educational.
• Works directly with medical supply vendors on unknown charges in the system when needed.
• Thoroughly researches payor contracts to formulate manual cost estimates on complex cases or when historical data is not available.
• Utilizes appropriate coding guidelines to properly assign ICD-10 and CPT codes to patients.
• Other related duties as required.

Physical and Environmental Demands

• Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects.
• Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
• The incumbent has no occupational risk for exposure to communicable diseases.
• There may be occupational risk for exposure to hazardous medications or hazardous waste within the environment.