Revenue Integrity Chargemaster Analyst

Overview

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Ann & Robert H. Lurie Children's Hospital of Chicago

General

Summary:

The Revenue Integrity Chargemaster Analyst is responsible for maintaining the integrity of the revenue capture system for the organization. Maintaining an accurate and compliant charge capture system is critical to the fiscal strength of the organization. This role conducts prospective audits of patients’ charts to ensure billing accuracy.

• Oversees maintenance of the charge master (CDM). Reviews, approves and builds all new charges. The review includes CPT (Current Procedural Terminology) codes, HCPCS codes, pricing, revenue codes and appropriate usage. Ensures all charges are tested and fully integrated with other systems as appropriate, including supply systems and department preference lists.
• Updates the CDM annually based on changes published by the AMA via CPT guidelines; updates quarterly based on CMS guidelines for HCPCS codes.
• Acts as primary liaison to clinical departments for annual CPT/HCPCS updates and ad hoc changes. Works with Information Management to ensure new and deleted codes are implemented appropriately. Develops coding education for internal departments and serves as a resource to revenue generation departments in establishing new charges or questions around existing charges.
• Oversees billing edit processes including CCI and MUE, and other revenue capture initiatives captured by edits. Collaborates with departments to reduce pre-bill edits and achieve clean claims. Tracks edit volumes by type and department to identify and assist with resolutions as necessary.
• Reviews CDM departments regularly to ensure accuracy of charge use, availability of charges, and charge reconciliation. Identifies opportunities and deficiencies. Works with a multidisciplinary committee to oversee and implement annual price increases and ensure fee schedules are updated accurately. May involve working with consultants and department leadership.
• Collaborates with all levels in the organization regarding opportunities and deficiencies. Provides recommendations for improvement and education as necessary. Performs follow-up reviews to ensure implementation of improvements. Develops corrective action plans and participates in compliance investigations as needed.
• Assists with the annual Revenue Integrity Workplan development and ensures adherence to the plan.
• Maintains an understanding of current Medicare, Medicaid, and commercial payer billing regulations and implements changes as related to CDM.
• Develops understanding of charge triggering systems used throughout the organization.
• Participates in projects, committees and system upgrades as necessary.
• Performs job functions with a customer-service focus on innovation, service excellence and teamwork to provide high-quality care and service to patients, families, co-workers and others.
• Other job functions as assigned.

• Bachelor’s degree required; master’s degree preferred. Relevant experience and/or training may be accepted in lieu of educational requirements.
• Coding Credential required within 6 months of employment. Required credentials include:
  Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Coding Specialist – Physician Based (CCS-P).
• Clinical discipline preferred.
• 3 years of CDM experience required.
• Epic CDM experience preferred.
• Epic Certification in Charge Capture required within one year.
• Strong analytical and financial skills required.
• Proficient with Microsoft Office:
  Excel, Word and PowerPoint.
• Strong verbal and written communication skills required.
• Worki…