Revenue Integrity Chargemaster Analyst

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.

680 Lake Shore Drive

General

Summary:

The Revenue Integrity Chargemaster Analyst is responsible for maintaining the integrity of revenue capture system for the organization. Maintaining an accurate and compliant charge capture system is critical to the fiscal strength of the organization. Conducts prospective audits of patient’s 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. Examples include supply systems, department preference lists, etc.
• Updates the CDM annually based on changes published by the AMA (American Medical Association) via CPT guidelines; updates quarterly based on CMS (Centers for Medicare and Medicaid) guidelines for HCPCS codes (Healthcare Common Procedure Coding System).
• 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. Acts as a resource to revenue generation departments in establishing new charges and/or questions around existing charges. Develops coding education for internal departments.
• Oversees billing edit processes including CCI and MUE, along with other revenue capture initiatives captured by edits. Collaborates with departments on developing process changes 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 on a regular basis or as defined in the Revenue Integrity Workplan. Review includes accuracy of charge use, review of charges available, charge reconciliation, and identifying opportunities and deficiencies. Works with a multidisciplinary committee to oversee and implement the annual price increase for organization. Ensures all fee schedules are updated accurately. May include working with consultants and the involvement of department leadership.
• Collaborates with all levels in the organization regarding opportunities and/or deficiencies. Provides recommendations for improvement and provides education as necessary. Performs follow up review 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 workplan.
• 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 adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
• Other job functions as assigned.

• Bachelor’s degree required, master’s degree preferred. Appropriate…