Charge Description Master Process Analyst

Children’s Hospital of Philadelphia•Philadelphia, PA

87d•Hybrid

About The Position

As a Charge Description Master (CDM) Analyst, you’re responsible for ensuring the accuracy, integrity, and upkeep of the facility Charge Description Master and physician practice fee schedules, working daily with the hospital pharmacy formulary and supply chain item master. We seek a resourceful, detail-oriented professional with strong research skills who can work independently, shift priorities smoothly in a fast-paced environment, and manage multiple tasks while delivering accurate, timely results; and also understand reimbursement and denial management. Excellent communication, problem-solving ability, and a commitment to quality are essential; experience with CDM management, fee schedules, pharmacy formulary, or supply chain item master is preferred.

Requirements

Associate's Degree Business, Healthcare or related field Required
At least three (3) years Hospital or physician revenue cycle, billing, or coding Required
Knowledge of healthcare revenue cycle functions, and billing and collection processes specific to the charge master. (Required proficiency)
Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claim forms. (Required proficiency)
Identifies data and analytic challenges including data integrity, appropriateness of data sample, context and consistency between sources. Fully leverages power of analytic tools (Required proficiency)
Experience supporting RI initiatives specific to implementation, and/or major process improvement and redesign. (Required proficiency)
Plans effectively yet is fluid based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener. Experience with coding, billing and CDM maintenance (Required proficiency)

Nice To Haves

Bachelor's Degree Business, Healthcare or related field Preferred
At least five (5) years Experience with coding, billing and CDM maintenance Preferred
Certified Outpatient Coder (CPC-H) - American Academy of Professional Coders (AAPC) - within 12 months - Preferred

Responsibilities

Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payor needs.
Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
Works with the RI Specialist and their revenue producing departments to ensure the ongoing coordinated consistency of the charge master and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
Work with analysts to perform applicable analyses to understand net revenue effect of proposed charge master and fee schedule changes.
Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims. Assists in researching coding issues and recommends solution to account representative. Identifies source of problem and works with analysts to implement corrective actions to ensure that the charge master is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement.
Assist in strategic pricing process to optimize reimbursement within budget guidelines.
Participate in ongoing coordination and resolution of revenue issues as they arise.
Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.
Performs other duties as assigned.