Revenue Integrity Chargemaster Analyst

Lurie Children's Hospital•Chicago, IL

2d•$65,520 - $107,120•Onsite

About The Position

The Revenue Integrity Chargemaster Analyst is responsible for maintaining the integrity of revenue capture system for the organization. Maintaining an accurate and compliant charge capture system is critical to the fiscal strength of the organization. Conducts prospective audits of patient’s charts to ensure billing accuracy.

Requirements

Bachelor’s degree required, master’s degree preferred. Appropriate experience and/or training may be accepted in lieu of educational requirements.
Coding Credential required within 6 months of employment.
Coding credential require: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Certified Coding Specialist – Physician Based (CCS-P)
3 years CDM experience required.
Strong analytical and financial skills required.
Proficient with Microsoft Office: Excel, Word and Power Point.
Strong verbal and written communication skills required.
Has working knowledge of clinical operations in a complex academic environment.
Strong research skills and the ability to understand and interpret billing and documentation regulations.
Ability to work independently and creatively.
Maintain independence, objectivity and professional skepticism.
Comfortable with using computers including the EMR.
Knowledge of billing processes used in healthcare organizations.

Nice To Haves

Clinical discipline preferred.
Epic CDM experience preferred.
Epic Certification in Charge Capture required within one year.

Responsibilities

Oversees maintenance of the chargemaster (CDM). Reviews, approves and builds all new charges. The review includes CPT (Current Procedural Terminology) codes, HCPCS codes, pricing, revenue codes and appropriate usage. Ensures all charges are tested and fully integrated with other systems as appropriate. Examples include supply systems, department preference lists, etc.
Updates the CDM annually based on changes published by the AMA (American Medical Association) via CPT guidelines; updates quarterly based on CMS (Centers for Medicare and Medicaid) guidelines for HCPCS codes (Healthcare Common Procedure Coding System).
Acts as primary liaison to clinical departments for annual CPT/HCPCS updates and ad hoc changes. Works with Information Management to ensure new and deleted codes are implemented appropriately. Acts as a resource to revenue generation departments in establishing new charges and/or questions around existing charges. Develops coding education for internal departments.
Oversees billing edit processes including CCI and MUE, along with other revenue capture initiatives captured by edits. Collaborates with departments on developing process changes to reduce pre-bill edits and achieve clean claims. Tracks edit volumes by type and department to identify and assist with resolutions as necessary.
Reviews CDM departments on a regular basis or as defined in the Revenue Integrity Workplan. Review includes accuracy of charge use, review of charges available, charge reconciliation, and identifying opportunities and deficiencies. Works with a multidisciplinary committee to oversee and implement the annual price increase for organization. Ensures all fee schedules are updated accurately. May include working with consultants and the involvement of department leadership.
Collaborates with all levels in the organization regarding opportunities and/or deficiencies. Provides recommendations for improvement and provides education as necessary. Performs follow up review to ensure implementation of improvements. Develops corrective action plans and participates in compliance investigations as needed.
Assists with the annual Revenue Integrity Workplan development and ensures adherence to the workplan.
Maintains an understanding of current Medicare, Medicaid, and commercial payer billing regulations and implements changes as related to CDM.
Develops understanding of charge triggering systems used throughout the organization.
Participates in projects, committees and system upgrades as necessary.
Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
Other job functions as assigned.

Benefits

Medical, dental and vision insurance
Employer paid group term life and disability
Employer contribution toward Health Savings Account
Flexible Spending Accounts
Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
403(b) with a 5% employer match
Supplemental Life, AD&D and Disability
Critical Illness, Accident and Hospital Indemnity coverage
Tuition assistance
Student loan servicing and support
Adoption benefits
Backup Childcare and Eldercare
Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
Discount on services at Lurie Children’s facilities
Discount purchasing program