Clinical Revenue Integrity Analyst
Our client has a contract opening for a CDM/Revenue Integrity Analyst in the Medical Center of Irving, Texas. In this role you will direct ongoing CDM reviews ensuring the accuracy and completeness of the departmental charge masters, which encompasses the coordination, monitoring and approval of all changes made to department CDMs.
- Directs ongoing CDM reviews ensuring the accuracy and completeness of the departmental charge masters, which encompasses the coordination, monitoring and approval of all changes made to department CDMs.
- Performs retrospective chart reviews comparing clinical documentation to charges posted to patient account to assess accuracy and completeness of department charge capture.
- Reduces compliance risks through studying, reporting and making recommendations relative to on-going and emerging compliance issues.
- Oversees the annual review of the CDM through meetings with clinical departments.
- Participates in project teams reviewing system programs/services relative to the development and/or changes to hospital CDM.
- Performs ongoing monitoring of estimated gross revenue impact, directly related to already strengthened internal controls, driven by Revenue Integrity audits/reviews.
- Serves as the primary contact for all charge-related Patient Financial Services inquiries and issues.
- Works with Managed Care to gain an understanding of claims filing and coding requirements affecting reimbursement from major Managed Care payors.
- Audits Epic preference lists and documentation flow sheet rows quarterly, to ensure revenues originating from these charging mechanisms are accurate, complete and compliant.
- Follow-up on billing issues created by charge capture errors.
- Provides assistance in completion of annual pricing review. This includes preparing the files requested and making price changes in the Epic Fee Schedule master file as requested.
- Distributes monthly EAP/CDM reports to departmental management on a monthly basis.
- Maintains current knowledge of Epic functionality as it relates to charging mechanisms and EAP build.
- Assists in the completion and verification of changes stemming from the annual CDM review.
- Documents discussions and maintains meeting minutes to assess whether hospital-wide education is needed on a given charging topic.
- Reports, investigates, and assists in resolution of compliance issues related to the CDM.
- Supports Clinical Operations administering education through Children’s CHEX system.
- Resolves errors identified through the Epic work queues related to CDM records (i.e., High-Dollar and Zero Price work queues)
- Develops and presents educational material for department management regarding the following: CDM update and maintenance procedures for billing codes and pricing; procedures for
- CDM “new item” requests; department-specific changes to charging/billing regulations affecting the CDM; the relationship of the CDM to productivity measures and ultimate facility reimbursement; importance of capturing revenue through the establishment of a complete department CDM; and education and development of viable charge reconciliation procedures.
- Two-year Associates Degree
- Four-year Bachelor’s degree (Preferred)
- Must have CPT Coding, chargemaster and charge capture working knowledge.
- Must understand regulatory guidelines related to coding/charging.
- Must have working knowledge of CCI Edits.
- 2 years of experience in progressive healthcare revenue cycle experience.
- Strong working knowledge of CPT and HCPCS codes, Revenue codes, NCCI edits, and OPPS guidelines as they relate to CDM.
- Ability to understand medical terminology, human anatomy, medical record documentation, insurance terms, and billing functions throughout the complete revenue cycle.
- Capable of interpreting CMS memos/bulletins as well as other payer communications.
- Certification in Epic HB, EAP, and FSC Epic Master Files.
- Extensive experience using spreadsheet and database computer applications this includes development of reporting tools to support management decision-making.
- RHIA, RHIT, and/or Coding Certification.