Revenue Integrity Analyst
With minimal supervision, utilizes Charge Description Master (CDM) management software to maintain a complete, accurate and standardized CDM, with uniform data elements and consistency with clinical practice; provides support, education and guidance to Clinical and Administrative Departments in order to maximize appropriate revenue for the system. The Revenue Integrity Analyst will also be responsible for reviewing, analyzing, and trending information being reported in order to identify the root-cause of issues and facilitate operational changes to improve net revenue and reductions in denials.
- Processes CDM additions, deletions and change requests while maintaining compliance with local, state and federal regulatory agencies.
- Monitors government and commercial payers for updates and changes to billing requirements. Communicates and educates clinical and administrative staff on any actions required to comply with new regulations.
- Identify when rebilling is needed and coordinate the rebilling process with the Clinical & Fiscal Integration Team and Patient Financial Services.
- Responsible for the training of hospital departments regarding compliant charge practice; the CDM maintenance process; annual CPT/HCPC code updates; and charge capture improvement.
- Performs detailed, annual review of the CDM and CPT/HCPC code changes and updates Meditech and Craneware systems.
- Collaborates with the clinical departments and enterprise Information System team to ensure that the appropriate ancillary/clinical modules are updated appropriately.
- Serves as subject matter expert related to charging and billing issues and assists in developing and maintaining CDM related policies and procedures.
- Audits charges being captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended.
Required Knowledge and Skills
- Experience with chargemaster maintenance or proficient knowledge of chargemaster components (CPT, HCPCs, Revenue Codes)
- Experience using Craneware Charge Master Toolkit and Meditech Patient Accounting
- Knowledge of CPT-HCPCS, third party reimbursement methodologies, and revenue cycle process
- Thorough understanding of the CDM relationship to general ledger, cost accounting, cost reporting, budget, coding, billing and compliance in a hospital setting
- Expert knowledge of inpatient and outpatient billing requirements, coding guidelines and CMS Medicare reimbursement methodology
- Must be flexible and be able to adjust in changing environments, including traveling to each Steward facility
- Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others
- Strong quantitative, analytical and organizational skills
- Ability to respond to complex inquiries in a professional and efficient manner
Education and Experience
- Education: Bachelor’s degree in Nursing, Accounting, Finance, Healthcare Administration or Business Administration or 3 years of direct chargemaster experience.
- Experience (Type & Length): Minimum five years health care with three years chargemaster or billing or coding.
- Certification/Licensure: Certified coder a plus.
- Software/Hardware: Proficient in using Microsoft Excel, PowerPoint and Word.