The CDM Analyst is responsible for oversight and maintenance of the hospital and professional Charge Description Master (CDM) within the Phoenix Children’s Hospital 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.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
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.
- 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.
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.
- Performs extensive research on regulatory guidelines and payer policies to address compliance, coding, and billing related inquiries related to the CDM.
Perform Daily 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.
Collaborate with Other Departments
- 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.
Perform Quarterly CDM Maintenance
- Performs quarterly maintenance on the CDM including updates to Addendum B and the MPFS, analysis of new CPT/HCPCS, and material changes to reimbursement.
Perform Root Cause Analysis Resulting from 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.
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.