Revenue Integrity and CDM Analyst Senior-Day-Full-Time

Schedule Information 

Monday-Friday 7:00am-3:30pm Remote Opportunity

General Summary

Is the technical subject matter expert responsible for supporting and maintaining the ongoing Charge Description Master (CDM) within WellSpan entities. The role assists in the planning, implementation and management of CDM process improvement initiatives and projects that support business needs. Project work is strategic and requires the facilitation of change management and process improvement techniques and methodologies related to the corporate CDM. Position determines CDM codes in compliance with Medicare, Medicaid and Commercial guidelines. This position manages work assignments, provides guidance in coordinating projects, managing deliverables and serves as a resource for ad-hoc problem solver, and troubleshooting. This position works on special revenue projects as directed by the Revenue Management leadership.

Duties and Responsibilities

Essential Functions:

• Responsible for the coordination of ongoing CDM consistency within revenue producing departments, which includes maintaining accurate charge descriptions, CPT/HCPCS coding, modifier and revenue code assignments.
• Maintain an extensive working knowledge of the hospital revenue cycle process to aid in the implementation of regulatory standards that assist in cash collections while accurately complying with billing guidelines.
• Performs extensive research analyses, identifies trends and reviews denials from Patient Financial Services related to payer rejections and incomplete reimbursement resulting from CDM issues.
• Develops corporate CDM requests for additions, deletions and other changes to ensure an accurate charge master database.
• Develops charge master educational training materials, job aides, tip sheets and provides support and training in charge master and charge capture concepts.
• Monitors quarterly Federal and commercial bulletins for HCPCS/CPT code changes and additions and Epic programming rule changes that affect charge functions.
• Facilitates the implementation of annual Outpatient Prospective Payment System final rule and annual AMA coding changes for all hospital clinical services within WellSpan.
• Works with Revenue Analytics, Finance and Clinical Management to understand budget and net revenue impact resulting from CDM charge changes.
• Lead in revenue optimization initiatives and collaborates with revenue cycle business partners on system enhancements and upgrades.
• Maintains a working knowledge of applicable Federal, State regulations, WellSpan Health Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
• Coordinates CDM reviews with management, Compliance and outside consultants, as needed.

Common Expectations:

• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Incorporates written and verbal skills with various personnel to enhance communication regarding CDM matters. Prepares written summaries and detailed standard and ad-hoc reports of findings and opportunities.
• Coordinates and integrates services within the department/organization, with other departments/service lines/entities, and with the System's primary functions; Participates in the selection of outside services (if needed).
• Develops, establishes and implements goals, objectives, and policies and procedures for department/system operations, and which guide and support the provision of the department/system's services.

Travel Requirements:

• Estimated Amount: - Must be able to travel to the various WellSpan Health hospital sites. Less than 10% travel is necessary for this position.

Qualifications

Minimum Education:

• High School Diploma or GED Required
• Bachelors Degree In a health services discipline Preferred

Work Experience:

• 5 years Coding and reimbursement experience Required and
• Inpatient/outpatient coding systems and coding compliance Required

Licenses:

• Certified Outpatient Coder Upon Hire Required or
• Certified Coding Specialist - Physician Based Upon Hire Required or
• Certified Professional Coder Upon Hire Required

Knowledge, Skills, and Abilities:

• Extensive knowledge of hospital financial operations including CDM development and rev