Revenue Integrity-CDM Analyst

Primary Purpose

Responsible for Charge Description Master (CDM) Set-up and charge generation process. Responsible for preparing and reporting data required to obtain appropriate reimbursement from payers. Responsible for CDM compliance with governmental payer requirements through preparation of financial reports and process monitoring to reflect facility and department activities. Responsible for working with EPIC IT Teams to improve the accuracy of charge build. Responsible for analyzing, compiling, documenting and reporting on data and exports. Responsible for informing and providing insights to Management using available data resources.

Minimum Specifications

Education

- Bachelor's degree in Business Administration/Nursing/Accounting or related field required.

Experience

- Must have two (2) years of experience in health care.

Equivalent Education and/or Experience

- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above

Required Tests for Placement

- Must be able to successfully pass the Intermediate-level Microsoft Excel test, as established by Workforce Planning & Recruitment, with a minimum score of 70%.

Skills or Special Abilities

- Must have effective oral and written communication skills.

- Must be proficient with computerized spreadsheet and word processing software

- Must be able to understand and apply Current Procedural Terminology (CPT), Healthcare Common Procedural Coding (HCPCS), and revenue codes to monitor proper usage and assure accurate billing procedures.

- Must be proficient with an understanding of data, relational database, Excel, Access & Word.

- Must have a working knowledge of hospital operations, strong computer skills, and understand patient and financial accounting systems.

- Must be proficient with computerized spreadsheet and word processing software.

- Must have a working knowledge of hospital operations, strong computer skills, and understand patient and financial accounting systems.

- Prior experience of working with EPIC EMR system is preferred with an understanding of flow & setup of procedures with different EPIC modules like Radiant, Beaker, etc. Responsibilities

Responsibilities

1. Responsible for promoting adherence to applicable State/Federal laws and regulations and the program requirements of accreditation agencies and Federal/State and private health plans in requests for third party reimbursement. Researches Research applicable laws, regulations and supporting documentation in the analysis of charge master, cost reporting, or other governmental reimbursement requests.

2. Reduces risk to Parkland by identifying, documenting documenting, and reporting potential compliance issues within their specific area of accountability, such as analysis of timely contractual and liabilities or charge master coding reviews. Audits established processes and procedures to detect errors or irregularities, assuring compliance with laws, regulations, and guidelines of Federal/State programs.

3. Analyzes payer requirements and pursues reimbursement through cost report settlement or charge capture or pricing opportunities. Performs strategic financial planning, using familiarity with payer requirements, to identify third party monies available through claims or settlement mechanisms.

4. Coordinates data required for external audits, assuring timeliness and completion of projects. Documents and computes impact of possible compliance issues according to department procedures.

5. Identify opportunities and make recommendations for interdisciplinary and department process improvement such as analyzing Return to Providers (RTPs) or work queues. Lead department teams to implement changes, creating work plan and department procedures required.

6. Acts as a Revenue Integrity liaison with various EPIC IT teams handling various modules to setup and maintain accurate flow of charges. Works closely with EPIC HB/PB setup teams to review the accuracy of build.

7. Coordinates or assists in special projects within the finance area, such as determining the effects of proposed or implemented changes in reimbursement rules or providing support during cost reporting, pricing or chargemaster maintenance.

8. Maintains positive working relationships with other hospital departments such as Patient Financial Services, Medical Records, Compliance, and the Medical Staff Office to ensure that the responsibilities of the department are performed in an expeditious and thorough manner.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.