REVENUE INTEGRITY COORDINATOR

Samaritan Health Services•Portland, OR

2d•Onsite

About The Position

The Revenue Integrity Coordinator is responsible for supporting and maintaining the Charge Description Master (CDM) for all Samaritan Health entities. Responsible for the accuracy and completeness of the CDM and the interface of charges into the system and the linking of charges and services to the clinical build. The CDM Coordinator supports the Revenue Cycle team as well as Patient Financial Services and individual Department Managers. Assists the Charge Master Committee in the development of charge reconciliation reports and supports all audit, CDM and revenue and usage activity. Responsible for assisting in the build of the system wide CDM Tool as well as developing a process with IT to interface all charges and new codes into the billing and medical record system in order to ensure an accurate and timely Revenue Cycle. The Charge Integrity Coordinator oversees the integrity of the pricing of the CDM and the pricing maintenance in the Cerner systems and audits the charges after interfacing them in the system in collaboration with the CDM Analyst. The Charge Integrity Coordinator will be the subject matter expert relating to the CDM structure, CPT, HPHCS, revenue codes, industry trends, and deferral, state and payer regulations and guidelines.

Requirements

Bachelor’s degree in business administration, Accounting, Health Care Information Technology, Computer Science or a related area and/or equivalent combination of training and experience.
Minimum of three (3) years relevant experience in CDM Management or IT.
Experience with large scale, automated patient billing systems, medical terminology and coding.
In depth knowledge of electronic data interchange and claims processing, third party payer rules, reimbursement practices and regulatory guidelines.
Experience working with revenue cycle information systems or system implementation teams for complex projects, application development and/and or support.
Strong Excel Skills required.
Technical knowledge of all revenue generation sources, including CDM, Charge Capture, CDI, Coding and all other related issues.
In depth knowledge of the hospital and physician practices, procedures and all health care concepts related to healthcare revenue cycle and its component operations, including billing, collections, charge capture, coding compliance, managed care contractual terms, Medicare and Medicaid reimbursements, third party reimbursements and cash management.
Ability to interpret a large volume of data and report it in a concise, meaningful manner.
Ability to use billing codes including CPT, HCPCS, Revenue Codes and ICD-10 codes.
Proficiency in working with complex and large volumes of data.
Strong problem-solving skills.
Ability to work in a fast paced and changing environment.
Strong organizational and written/oral communication skills.
Ability to work independently and with little supervision.
Excellent ability to manage to deadlines.
Professional attitude required in challenging conditions.

Nice To Haves

Patient Accounting experience preferred.
Coding Certification (CPC, COC, CCA, CCS, and RHIT) Preferred.
Clinical experience a plus.
MediTech CDM and Charge Capture preferred.
Charge Capture/Coding/Clinical Documentation analysis experience preferred.

Responsibilities

Perform daily reviews/analysis of charging errors, working with all Samaritan Health hospital and physician departments.
Investigates, analyzes, and recommends actions and solutions for registration, coding, charge entry, cash collection, posting and balance problems.
Effectively support the Charge Description Master Maintenance coordination activities in a timely manner, including charge additions, CPT/HCPCS code changes, and pricing updates.
Work with Charge Integrity Auditors and Revenue Cycle to identify, analyze and resolve CDM-related claim submission issues.
The CDM Coordinator will assist in the implementation and system build of the annual price adjustment.
Participate in testing, validation and implementation of all system enhancements and upgrades to ensure that functionality, validation, transparency, charge and price accuracy is maintained.
Evaluates, develops, and implements computer based departmental charge processes in collaboration with operating departments and ITG.
Processes CDM additions, deletions and change requests in all systems, to maintain regulatory compliance and meet operational requirements.
Collaborates with clinical departments and Samaritan Medical resources to ensure appropriate inpatient, ancillary, clinical and billing modules are aligned with regard to standardized CDM maintenance process, quarterly and annual CPT/HCPCS updates.
Identifies clinical workflows that will impact design build.
Evaluates consistency of data across financial and clinical systems to ensure CDM data is interfaced appropriately and consistent.
The CDM Analyst provides support for special projects which includes but is not limited to, collecting and analyzing revenue and usage claim data for the hospital, physicians and provider groups in preparation for regular changes to charging, transparency regulations and an assessment of utilization changes for operational leadership.