Chargemaster Analyst

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Position Details

Department: CORP | Revenue Integrity
Location: Telecommuting
Shift: Mon-Fri, Days, 8am-5pm
Category: Patient Financial Services
Posting #: 1074738
Employee Type: Full-Time

Position Summary

The CDM Analyst is responsible for oversight and maintenance of the hospital and professional Charge Description Master (CDM) within the Phoenix Children's and all subsidiaries. As part of Revenue Integrity Department, the CDM Analyst will collaborate with multiple teams to ensure an efficient CDM maintenance process exists, resulting in clean and compliant claims. This position acts as liaison, problem solver and facilitator for CDM issues with Administration, Insurance Companies, Clinical Departments, Health Information Management, Utilization Management, Managed Care, Corporate Compliance and Revenue Cycle.

Position Duties

  • Support Revenue Integrity Team and Phoenix Children`s Strategic Revenue Cycle Plan
    Supports the Revenue Integrity Team and Phoenix Children’s strategic Revenue Cycle plan by maintaining the CDM to ensure services rendered are accurately reported and reimbursed while maintaining compliance with all Federal and State regulations, payer policies, and coding guidelines.
  • Collaboration
    Collaborates closely with the Revenue Integrity Team, all revenue producing Clinical Departments, Compliance, Hospital & Physician Business Offices, Transplant Revenue Cycle, Health Information Management (HIM), Information Technology (IT), Managed Care, and Finance to facilitate proper coding and billing outcomes.

    Collaborates with IT, Clinical Departments, etc. to establish accurate mapping and data flow from each subsystem to the CDM to ensure services rendered are accurately reported and reimbursed.
  • Coordinate and Facilitate
    Coordinates and facilitates the Chargemaster Oversight Group (COG) comprised of members from across the organization impacted by CDM related activities.
  • Monitors Federal, State and Payor Bulletins
    Monitors Federal, State and Payer bulletins to identify updates that directly impact the CDM and proactively communicates applicable changes to the Clinical Departments affected.
  • Perform Research and Root Cause Analysis Resulting from CDM
    Performs extensive research on regulatory guidelines and payer policies to address compliance, coding, and billing related inquiries related to the CDM.

    Performs root cause analysis resulting from the CDM to resolve payor denials, coding/billing edits, and/or other delays or reductions to cash flow.
  • Perform Daily and Quarterly Maintenance on CDM.
    Performs daily maintenance on the CDM including the addition of new charge codes, the inactivation of charge codes no longer performed/utilized and updates to Description, CPT/HCPCS, Revenue code, Modifier, Price, etc.

    Performs quarterly maintenance on the CDM including updates to Addendum B and the MPFS, analysis of new CPT/HCPCS, and material changes to reimbursement.
  • Implements Process Improvement
    Implements process improvement strategies designed to streamline workflow, automate, and optimize technologies utilized as part of the CDM maintenance process.
  • Provides Focused Education
    Provides focused education to clinical and coding stakeholders and best practice recommendations for improvement, as it relates to the CDM.
  • Assist with Validating Annual Pricing
    Assists with validating annual pricing updates to the CDM to ensure accuracy and to optimize reimbursement within Phoenix Children’s budget requirements.
  • Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.

Education

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Bachelor`s degree in business, finance, data analytics, healthcare administration or health information management
Required
2. MBA, MSN or Master`s Degree
Preferred

Experience

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Five (5) years of healthcare revenue cycle experience demonstrating extensive CDM and compliance experience, ability to collaborate with multidisciplinary teams, and a solid foundational knowledge of general healthcare billing, Federal and State regulatory guidelines and payer policies, and compliant charge capture.
Required
2. Experience with hospital and professional coding guidelines, revenue audits, reimbursement methodologies, and system integration with the CDM relative to charge capture.
Required
3. Career appropriate experience based on job description essential functions.
Required

Special Skills

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Expert knowledge of hospital and professional CDM structure and coding rules with effective research skills to ensure accuracy and compliance with regulatory guidance.
Sound knowledge of general healthcare billing, payer contracting and reimbursement, and applicable Federal and State laws and regulations related to the healthcare industry.
Required
2. Proven ability to determine key business issues and develop effective action plans from multi-disciplinary perspectives.
Demonstrated ability to effectively maintain subsystem integration with the CDM to optimize charge capture, identify revenue leakage and assist with root cause analysis.
Required
3. Excellent organizational and project management skills with a focus on time sensitive management and the ability to prioritize.
Excellent communication and interpersonal skills, with the ability to communicate effectively in English, both verbally and in writing.
Required
4. Ability to impact change through influence and collaboration. Self-starter, well organized, and detail oriented.
Required
5. Proficient in electronic health systems and Microsoft Office applications including: Outlook, Word, Excel, PowerPoint, Visio, and Access.
Required

Additional Requirements

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Coding credential through AHIMA or AAPC (e.g., CPC, COC, CCS, CIRCC, RHIT, etc.).
Required
2. Healthcare Compliance credential (e.g., CHC, CRCM, CCEP, etc.).
Preferred
3. Nursing credential (e.g., RN, etc.).
Preferred
4. LEAN or Six Sigma training and certification
Preferred

Certification / License / Registry Requirements for the Position

1. Certified Coding Specialist OR Cert Professional Coder OR Reg Health Information Tech OR Cert IR Cardio Coder OR Certified Outpatient Coder - Required

Physical Requirements & Occupational Exposure/Risk Potential

1. Physical Requirement - Climbing - Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) - Constantly
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Constantly
4. Physical Requirement - Hearing - Constantly
5. Physical Requirement - Pushing/pulling - Occasionally
6. Physical Requirement - Reaching - Frequently
7. Physical Requirement - Sitting - Constantly
8. Physical Requirement - Standing - Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally
10. Physical Requirement - Talking - Constantly
11. Physical Requirement - Tasting/smelling - Occasionally
12. Physical Requirement - Walking - Frequently
13. Physical Requirement - Near Vision - Constantly
14. Physical Requirement - Far Vision - Frequently
15. Physical Requirement - Color Discrimination - Frequently
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance - Occasionally
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply