Mgr., Revenue Integrity-CDM

Parkland Health

About The Position

Primary Purpose Oversee the setup in the Charge Description Master (CDM) for all revenue generating departments while managing the daily functions of the Revenue Integrity-CDM and Registered Nurse Auditor teams. Responsible for function related to the build and maintenance of the Charge Description Master (CDM) for Parkland Health and Hospital Systems. The Manager must possess and maintain advance knowledge of the CDM build and maintenance process within EPIC. This manager is also responsible for the analysis and assessment of diverse data related to the revenue cycle. The Manager of the Revenue Integrity-CDM team plays a leadership role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Will provide essential quality reports and advice and improvement recommendations to leadership along all revenue generating service lines for the hospital system. Required to understand and communicate complex issues and changes relating to regulatory compliance and third-party reimbursement to all of the department(s) involved, maintain records of their notification, accountability, and compliance.

Requirements

Bachelor's Degree in Accounting, Business, or Healthcare related field, preferred.
Six years of experience in Healthcare, Revenue Cycle Management and Third-Party Billing.
Must have six years of experience in management or leading in processing Charge Description Master Request.
Thorough knowledge of, charge capture, charge integrity reconciliation, charge auditing, strategic pricing, and revenue optimization.
Extensive knowledge of federal regulations and policies pertaining to documentation, coding, and billing.
Must have knowledge of CPT/HCPCS coding and revenue coding.
Must be able to successfully pass the Intermediate-Level Microsoft Excel test, as established by Workforce Planning & Recruitment, with a minimum score of 70%.
Must be able to effectively supervise, educate, and train employees.
Must have EPIC certification or proficiency in CDM management.
Strong Analytical skills required.
Must have strong computer skills using MS Excel and Word and the ability to learn various software.
Must be able to successfully pass the Intermediate-Level Microsoft Excel test, as established by Workforce Planning & Recruitment, with a minimum score of 70%.
Must have a working knowledge of hospital operations and understand patient and financial accounting systems.
Must have effective project management skills.
Strong customer service and communication skills are essential for responding to requests and explaining analyses.
Expertise with CPT, HCPCS, and Revenue coding with ability to process changes.
Must have a thorough understanding of medical terminology.
Must be able to interact tactfully and effectively with physicians, clinicians, nurses, and other inside and outside of PHHS's organization regarding charging rules and regulations.
Must be familiar with review and interpretation of terms and conditions commonly within Managed Care contracts.
Must have effective verbal and written communication skills.
Must have critical thinking and problem-solving skills.

Nice To Haves

EPIC experience strongly desired.
Clinical experience strongly desired.
Current RN license or valid temporary permit with the Texas Board of Nursing; or, valid Compact RN license, desired.

Responsibilities

Manages Charge Description Master CDM research and maintenance in accordance with federal billing and coding guidelines.
Assures accurate and timely implementation of CDM additions, deletions and changes to minimize Medicare Return to Provider (RTPs) and other billing issues.
Identifies and analyzes departmental requests for changes to CDM.
Review/identify/analyze necessary CPT/HCPCS code changes related to annual and quarterly updates from regulatory agencies.
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 and required.
Ensures CDM updates occur on a regular basis in both the billing system and in the current eCDM vendor hosted maintenance tool.
Initiate regular communication with CDM maintenance vendor regarding billing and charging issues related to the eCDM.
Train new users in using the eCDM maintenance tool.
Will function as the liaison between departments, Information Technology, and Revenue Integrity with the goal of creating an efficient charge generation process that promotes timely charge capture and billing required to expedite the reimbursement process.
Will identify charge generation process between EPIC and the end user.
Performs periodic reviews of the CDM as needed or as requested clinical departments or by the Revenue Integrity Director.
Reduces risk to Parkland by identifying, documenting and reporting potential billing and compliance issues within their specific area and accountability, or charge master coding reviews.
Audits established departmental charging processes and procedures to detect errors or irregularities, assuring compliance with laws, regulations, and guidelines of regulatory agencies.
Documents and computes effect of possible compliance issues according to department procedures.
Will assist with managing EPIC Billing projects, such as, CDM Reconciliation project, Charge Capture project, Physician Billing Project, and others to ensure PHHS's remain as close to EPIC's best Practice with the aim of improving or charge generation and billing process.
Will maintain the CDM Matrix and the CGT Matrix files that contain the charge generating data for all active charges currently maintained in our CDM of Technical and Professional charge.
Monitors and tracks staff productivity and quality through routine productivity and quality assurance audits and initiatives.
Provides guidance coaching mentoring and feedback to ensure successful operations.
Will work with the supply charging process hospital-wide to encourage and support real time pricing for supplies. This will reduce the number of items maintained in the CDM for supplies and ensure better charging for supplies as supply pricing will be based upon the current acquisition cost instead of being priced in the CDM.
Assist the department Director in making objective, analytical, and compliant management decision affecting the operating interest of Parkland, including possible growth, expansion and new profit opportunities.
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 charging and billing responsibilities of the department are performed in an expeditious and thorough manner.
Stays abreast of the latest developments, advancements and trends related to regulatory changes by attending seminars/workshops, reading professional journals, actively participating in professional organization, and /or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that affect the functional area. Develops and maintains documentation relative to regulatory changes. Provide ongoing education to billing and clinic teams as it related to regulatory coding and billing changes.
Identifies and analyzes and works with the Manager of Revenue Integrity Charge Capture regarding the design of jobs, work processes, workflows, etc. for the department as it relates to charging and billing of its services and implements appropriate changes to improve effectiveness, productivity and efficiency.
Will work closely with the Charge Capture team to resolve charge generation issues that may delay the billing process.
Coordinates or assists in special projects within the Revenue Integrity department as assigned by management
Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
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.
Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.