Revenue Integrity Charge Description Master Coordinator

Job Summary :

Coordinates with system and local Revenue Integrity leadership to monitor and facilitate the maintenance of assigned Charge Description Master (CDM) to support technical and operational alignment in support of accurate and timely charges.

Partners collaboratively with stakeholders, providing Revenue Integrity subject matter expertise to support efficient charge alignment in compliance with state and federal regulations.

Maintains alignment with system standards, governance and protocols established with Revenue Integrity leadership, supporting the implementation of system-wide standardization, special projects and strategic initiatives to meet expanding and changing needs of the organization.

Acts as agent of change, in the continuous monitoring and maintenance of assigned Charge Description Master (CDM) scope, facilitating changes and training as needed.

Provides clinical department managers and their charge capture staff with direction pursuant to applicable Centers of Medicare and Medicaid Services ( CMS ) and industry standard billing regulations / guidelines to ensure compliant billing and accurate / complete charge capture inclusive of acute, hospital-based outpatient clinics, rural health clinics, technical and acute services.

Job Requirements :

Education and Work Experience :

• High School Education / GED or equivalent : Preferred
• Associate’s / Technical Degree or equivalent combination of education / related experience : Preferred
• Five years' relevant experience : Preferred

Essential Functions :

Manages the assigned system or local hospital and physician billing chargemaster (CDM) in coordination with PFS and Coding, Charge Description Master (CDM) set-up and charge generation process.

Maintains CDM for all required elements, including but not limited to assignment of applicable CPT / HCPCS coding, UB-04 Revenue Codes, and appropriate pricing for acute technical and professional hospitals, hospital-based outpatient clinics, and rural health clinics.

Ensures assigned CDM remains compliant with changing billing and coding updates made by CMS, American Medical Association ( AMA ) and other government and commercial insurance payers, as applicable.

Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines.

Conducts meetings with service line clinical departments to ensure accurate charge capture and workflows processes are in place.

Identifies possible weaknesses in these processes and quantifies net revenue opportunities of such weaknesses. Coordinates with system Revenue Integrity leaders in developing and implementing changes to charge workflow processes and facilitates education and training to departmental staff to achieve net revenue opportunities.

Monitors metrics to understand and mitigate root cause issues of suspended charges and / or other charge related errors.

Represents the hospital and / or clinics to ensure all locations stay abreast of payor changes that impact reimbursement to include changes in authorizations and billing.

Assesses and processes all requested additions and changes to the CDM and works with the requesting clinical department's leadership and Revenue Integrity team to determine whether a process change(s) will be required.

Monitors and completes assigned Revenue Integrity work queues with accuracy and efficiency. Provides related education on charge reconciliation tools, reports, and practices to clinical department charge capture staff.

Works closely with various Information Technology Services application teams to ensure . system (., Cerner, Epic) is updated with appropriate billing / charge codes in the CDM and front-end clinical applications / order entry systems as required to capture charges.

Participates in meetings with service line clinical departments to ensure accurate charge documentation, capture and workflows processes are in place.

Identifies possible weaknesses in these processes and quantifies net revenue opportunities of such weaknesses.

Ensures that revenue codes, description nomenclature, patient billable versus non-billables, pricing, catalog development, updates (add / delete / change) and GL interfaces for all CDM items are appropriate.

Assesses and processes all requested additions and changes to the CDM and works with the requesting clinical department's leadership and Revenue Integrity team to determine whether a process change(s) will be required.

Performs other job-related duties as assigned.

Organizational Requirements :

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc.

as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.