PB CDM Analyst II
Job DescriptionUnder the direction of the CDM Manager, the Chargemaster Analyst II is responsible for the maintenance and monitoring of an integrated Epic based Charge Description Master (CDM). This position is responsible for completing CDM requests assigned by the Chargemaster Analyst I. Ensures that the CDM reflects clinical practice and aligns with the reporting requirements for government and major commercial third party payors. Responsible for supporting the integrity and accuracy of the CDM through annual, semi-annual, and quarterly CPT/HCPCS code updates, clinical practice changes and EPIC system upgrades. Creates and performs analysis on Chargemaster coding and financial data requests and reports. Identifies billing problems related to CDM including interface functionality, confirmation of accuracy of department charge capture tools to maintain data integrity across all billing systems.
- Creates and performs analysis on Chargemaster coding and financial data requests and reports.
- Develops results oriented coding and financial analysis based on research, fee schedules, dollars, trends, and operational relationships,(i.e. includes financial impact of implementing a given regulatory change, price change ramifications and gross impact).
- Draws valid conclusions, in collaboration with the Manager, based on researched evidence supportive to management decision making and suggests potential alternatives to conclusions, when applicable.
- Meets with operational personnel to discuss the approach and findings on a specific analysis or improvements realized through changing existing workflow.
- Assists Senior Financial Analysts and/or Management with Chargemaster related financial projects as needed.
- Demonstrates an ability to evaluate and maintain the proper level of Chargemaster data integrity through ongoing monitoring to identify potential billing issues related to CDM including interface functionality, confirmation of accuracy of the department charge capture tools or navigator screens
- Identifies and communicate pitfalls and obstacles that all users of billing & financial systems information might encounter.
- Ensures that coding & financial information provided is accurate, consistent and complete. Coordinates with IT, Revenue Integrity and Revenue Cycle Managers in addition to specific departments for successful implementation of any changes.
- Conducts troubleshooting of Chargemaster data as needed to enable billing, information systems and finance to initiate and/or remedy potential errors in reporting.
- Performs timely updates to the Chargemaster and pricing to ensure that the integrity of coding & financial data and the subsequent reporting of information derived from the CDM is accurate.
- Participates in annual CDM audits in accordance with annual workplan, coordinating with internal or external auditors.
- Collaborates with Revenue Integrity team in the development, execution and follow up of education related to the Chargemaster and CDM related processes.
- Generates and manipulates Chargemaster data using MS Office & system information system tools.
- Conducts research and monitors regulatory changes external to the System utilizing all valid available resources (Internet, periodicals, purchase sources, etc.).
- Identifies and successfully accesses data needed to complete accurate Chargemaster informational requests.
- Validates all data entry done by junior analysts related to Chargemaster systems for accuracy and completeness. Communicates with department leadership regarding missing or inaccurate CDM request information.
- Formats all CMS and proprietary fee schedules to maintain current information for CDM pricing and reimbursement requests.
- Supports additional projects and duties as assigned.
Bachelor's or 4 additional years of relevant experience
2 years of Hospital Chargemaster, advanced billing & coding, revenue cycle or related healthcare experience.
Certified Coder from an accredited professional organization (i.e. AAPC, AHIMA)
-Thorough understanding of CPT/HCPCS & UB coding & billing guidelines.
-Proficient in MS Office, especially formatting and analysis tools (Outlook, Excel, Word, Access).
- Excellent knowledge of medical terminology.
-Strong verbal and written communication skills and able to communicate effectively with all staff levels in English.
-Strong analytical skills, able to multi-task and is detail-oriented.
-Able to meet tight deadlines.
-Ability to understand and analyze payer regulations and impact on hospital reimbursement.
- Able to support and guide junior staff.
-Assists billing personnel in resolving claims issues related to Chargemaster.
- Working knowledge of EPIC and other health information systems (nThrive, Oracle etc.) Experienced with regulatory and manufacturer research desired.