As part of our continued commitment to providing a safe and healthy workplace, Phoenix Children’s is officially a mandatory COVID-19 vaccination organization, effective October 1, 2021. All new employees must be fully vaccinated prior to starting employment at Phoenix Children’s. Having a vaccinated workforce is an important step in supporting our mission to provide hope, healing and the best healthcare for the children in our community.
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Position Details

Department: CORP | Revenue Integrity
Category: Patient Financial Services
Location: Telecommuting
Posting #: 714239
Date Posted: 12/13/2022
Employee Type: Regular

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 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.

PCH Values

  • 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.

Position Duties

  1. 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.
  2. 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.
  3. Coordinate and Facilitate
    • Coordinates and facilitates the Chargemaster Oversight Group (COG) comprised of members from across the organization impacted by CDM related activities.
  4. 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.
  5. Perform Research
    • Performs extensive research on regulatory guidelines and payer policies to address compliance, coding, and billing related inquiries related to the CDM.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Implements Process Improvement
    • Implements process improvement strategies designed to streamline workflow, automate, and optimize technologies utilized as part of the CDM maintenance process.
  11. Provides Focused Education
    • Provides focused education to clinical and coding stakeholders and best practice recommendations for improvement, as it relates to the CDM.
  12. 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.
  13. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelor`s degree in business, finance, data analytics, healthcare administration or health information management Required
2. MBA, MSN or Master`s Degree Preferred
Do you meet this requirement?
Experience
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
Do you meet this requirement?
Certifications/Licenses/Registries
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.). Required
3. Nursing credential (e.g., RN, etc.). Preferred
4. LEAN or Six Sigma training and certification Preferred
Do you meet this requirement?
Special Skills
1. Expert knowledge of hospital and professional CDM structure and coding rules with effective research skills to ensure accuracy and compliance with regulatory guidance. Required
2. Proven ability to determine key business issues and develop effective action plans from multi-disciplinary perspectives. Required
3. Sound knowledge of general healthcare billing, payer contracting and reimbursement, and applicable Federal and State laws and regulations related to the healthcare industry. Required
4. Demonstrated ability to effectively maintain subsystem integration with the CDM to optimize charge capture, identify revenue leakage and assist with root cause analysis. Required
5. Excellent organizational and project management skills with a focus on time sensitive management and the ability to prioritize. Required
6. Ability to impact change through influence and collaboration. Required
7. Excellent communication and interpersonal skills, with the ability to communicate effectively in English, both verbally and in writing. Required
8. Self-starter, well organized, and detail oriented. Required
9. Proficient in electronic health systems. Required
10. Proficient with Microsoft Office applications including: Outlook, Word, Excel, PowerPoint, Visio, and Access. 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
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply