Charge Integrity Analyst

The Chargemaster System Administrator keeps the Charge Description Master (CDM) current and accurate with regard to changes requested by clinical departments, makes timely updates to the CDM whenever new regulations are published by the Centers for Medicare and Medicaid Systems (CMS), and communicates and coordinates their implementation with changes to the responsible department managers.

Essential Functions

• Responsible for maintaining the CareWell Health CDM by incorporating new charges/services and updating existing charges.
• Manages daily operation of the CDM and ensures that all CDM requests are processed and issues are resolved in an appropriate timeframe.
• Ensures the on-going accuracy and integrity of the CDM by making sure all charges are communicated and coordinated with the performing departments.
• Ensures necessary changes to charge documents and charge capture processes are implemented.
• Resolves problems causing payer denial or failed Medicare edits as they involve the charge master.
• Manages coding/regulatory changes and reviews involving the CDM with appropriate departments.
• Coordinates with Patient Financial Services, Health Information, and other coding professionals to ensure the codes contained in the CDM are accurate and in compliance with regulatory and/or contractual guidelines for accurate billing.
• Manages CDM Cerner projects including documentation, file building, testing, validation, workflow decisions, and implementation.
• Responsible for resolving CDM, non-CDM, and CPT table Cerner issues for all hospital areas.
• Works with all Cerner financial and clinical teams for all charging related parameters to implement and maintain Cerner ambulatory, clinical, and financial systems.
• Ensures the charging/coding aspects of the clinical Cerner systems meet regulatory and hospital pricing guidelines.
• Ensures non-CDM components of Cerner involved with charging are up-to-date and compliant.
• Reviews account issues including adding charges and troubleshooting root causes of Cerner and billing issues.
• Responsible for creating and analyzing daily CDM dashboard reports.
• Develops report specifications and works with Business Intelligence to ensure reports for operational needs are met.
• Builds new charges by reviewing, assigning, and validating CPT, HCPCS, and revenue codes and set prices.
• Works collaboratively with the revenue producing department staff and IT to ensure all charges are being captured and documented.
• Manages upgrades, user troubleshooting, and performs administrative responsibilities for the facility setup and maintenance for CDM/charging/pricing software programs.
• Educates EOGH departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.
• Other duties and/or projects as assigned.

Other Duties

Minimum Work Experience

• Bachelor’s level degree or equivalent relevant years of experience.
• Minimum of 3 or more years of experience in a related hospital billing department.
• Strong computer skills (i.e. Microsoft Office Suite, Google Business, etc.).
• Knowledge of Epic clinical and financial systems.
• Maintain continual knowledge on government & third-party regulations.

Position Type/Expected Hours of Work: Must be willing to work holidays, weekends and provide additional coverage as needed

Physical Demands Analysis: The following tables detail the individual physical demands using the following six categories: Mobility, Strength, Upper Extremity Postural Activity, Sensory/Perceptual, Work Environment, and Conditions of Work