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Revenue Integrity CDM- Analyst - Coding and Revenue Integrity

2131 South 17Th Street
Wilmington, NC
Job ID: 3026
Date Posted: May 11, 2021

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Job Description

Description

About NHRMC

NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.

About the Job

Location: New Hanover Regional Medical Center

Department: Coding and Revenue Integrity

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:

Works under the supervision of the Manager of Revenue Integrity & CDM This position assists with researching coding & billing guidelines, insurance contracts and updating the hospital Charge Description Master (CDM) to ensure accurate charge capture and compliance with third party payer requirements. Assists with maintaining charging policies and procedures that support a complaint charging process. Researches coverage and reimbursement issues as directed in CDM activity, or as assigned via other projects. As directed, disseminates information regarding billing/coding to the appropriate clinical and support departments. Assists with the distribution of billing requirements with the appropriate departments and individuals in the NHRMC external and internal environment. Ability to work with minimal supervision and has the ability to manage multiple priorities. Provides support for the CDM functions when the Manager is out of the office. May work on special projects/assignments concerning reimbursement implications on joint ventures and new initiatives as assigned.


Responsibilities:

  1. Assists in creating and maintaining all hospital charge codes. Responsible for build, updating and maintaining Epic assigned tables and categories.
  2. Maintains EPIC work queues daily, as assigned, and reviews other work queues that fall under revenue integrity. Assists revenue stewards with clearing work queues, or investigating issues, as needed.
  3. Reviews changes, additions, and deletions to the Charge Description Master file (CDM) and after approval, keys those changes and updates. Verifies the changes and updates were keyed and processed properly. Processes CDM requests to ensure that additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner.

4.Recommends the assignment of CPT/HCPCS codes and UB Revenue Codes to supplies and procedures, and assists with determining prices for new services and supplies. Research and recommend new charges and changes.

5.As directed, researches reimbursement and billing guidelines from payers for supplies, drugs, and procedures. Researches and resolves all Charge Description Master related code errors effecting revenue. Communicates findings to appropriate personnel.

6.Assists with the preparation of the timely implementation of the quarterly coding updates (CPT/HCPCS), periodic UB Revenue Code updates, modifier revisions, and regulatory updates related to Charge Master data. Notifies affected departments of changes, and notifies the appropriate management personnel when coding changes may impact net reimbursement, gross charges, productivity or internal processes. Works with appropriate management to assess and mitigate the impact to NHRMC.

7.Assists with the completion of the annual update/review of the CDM in a timely and efficient manner. Works with department management to ensure a seamless transition. Performs monthly reviews of the CDM to ensure UB Revenue Codes, HCPCS, CPT-4 and charge item descriptions match appropriately. Uses resources, such as nThrive, to identify necessary changes.

8.Researches and develops flow charts of Charge Codes and the flow of revenue through hospital applications and systems.

9.Assists with development of charge master policies for the Administrative Policy Manual and ensures they are current and departments are compliant. Prepares reports of non-compliant departments/issues for Coordinator review and follow-up.

10.Collaborates with the appropriate Informatics System Specialist and Clinical Subject Matter Experts (SME) to assist with maintaining the various table files within EPIC which are responsible for providing accurate CPT/HCPCS codes and revenue codes within EPIC based upon multiple payer requirements.

11.Collaborates with Reimbursement, Information Systems, and SMEs to assist with maintaining the CDM and appropriate ERX, EAP, and SUP records and their links to these records for pricing and fee schedule maintenance.

12.Works with the team to identify departments/programs highly impacted by regulatory changes which may require internal process or informatics system changes regarding charge capture. Develops a support plan to assist those departments with modifying current practices and procedures to mitigate impact to NHRMC cash flow and operations.

13.Assists in providing education and supporting information regarding CPT coding, billing and/or coverage changes to departmental and hospital personnel as needed.

14.Works with the Manager, providing modeling and impact analysis of changes in governmental program reimbursement (as assigned). and proposed charge master changes. This may include, but is not limited to, pricing analysis, new service revenue modeling and sensitivity analysis pertaining to applicable industry trends.

15.Analyzes data with the CDM and assigns accurate CPT/HCPCS and revenue codes to Charge Description Master to insure compliance with regulatory agencies. Assists with maintaining the nThrive application.

May work on special project/assignments and other duties as assigned.

Position Requirements

Credentials:
Essential:
* EPIC Certification

Education:
Essential:
* Bachelors Degree

Other information:

Education: Bachelor’s Degree or Associates Degree in Business, Healthcare Analytics, Health Information Management or a related degree required. Coding courses including CPT, Anatomy and Physiology, medical terminology preferred.

Licensure/Certifications: Must obtain Epic Resolute HB Charging/CDM certification within 12 months of start date. Coding certification from AHIMA or AAPC (CCS or CPC) preferred.

Experience: 1 - 3 years’ experience in hospital revenue cycle and/or financial analysis and/or decision support in a large hospital setting required. Proficient experience with Microsoft Excel. Desirable is work experience with billing edits, hospital charging, charge master principles and the relationship to coding, billing, and compliance in a hospital setting. Epic and nThrive experience preferred, but not required

Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence. 

Performs other duties as assigned. 

Individual will possess commensurate combination of education, experience and qualifications.  

Other Information

This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.

  • Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve. 
  • Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek. 
  • Forbes America’s Best Large Employers 2018 and 2019Link 
  • Becker’s 150 Top Places to Work in HealthcareLink 
  • Healthgrades Outstanding Patient Experience

Consider a career at NHRMC and become part of this award winning team!

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