Job Details

Responsibilities:

The CDM Analyst is responsible for supporting and maintaining the Charge Description Master (CDM), including being responsible for the accuracy and completeness of the CDM. The CDM Analyst also supports the CDM Coordinator and Senior CDM Analysts. Areas of responsibility include:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

1. Reviews and/or processes changes, addition and deletion requests for CDM updates.

2. Follows HELIOS required change control processes for all updates/changes needed.

3. Participates in CAB call for Service Now Tickets submitted by Clinical and/or Operational departments. Routes/assigns Service Now tickets to responsible CDM team members based on assigned departments.

4. Serves as technical resource for assigned clinical or business departments throughout HFHS. Responsibility includes, but is not limited to, the assessment of optimization efforts to meet system goals including patient safety, quality of care, charge capture and improving operational efficiencies.

5. Collaborates with EPIC Application teams, Reimbursement, Compliance, and SMEs to maintain/update/test the CDM and appropriate EAP records and their links to these records for pricing and fee schedule maintenance.

6. Supports timely implementation of coding updates (CPT/HCPCS), periodic UB Revenue Code updates, modifier revisions and regulatory updates to CDM. Assists CDM Team with communications to Clinical End Users, Revenue Integrity, Reimbursement, IT, HIM and others (as needed) when coding changes may impact net reimbursement, gross charges, productivity or internal processes.

7. Analyzes and processes charging and rate errors within EPIC Work Queues as well as other claim edit or charge review issues that occur.

8. Coordinates distribution of monthly CDM listings and reports to MedAssets and other users. Runs Jxports lists. Creates/runs other EPIC/CDM reports as needed.

9. Reviews and requests changes to preference lists (charge navigators).

10. Performs a variety of duties within EPIC including, but not limited to, creation of EAPs in POC (Proof of Concept) environment and test PB custom codes in POC or TST and updates fee schedule rates in POC for CDM Manager’s review.

11. Provides quality control check and audits that expected CDM changes have properly moved from test into the production environment.

12. With the CDM Manager and CDM Coordinator, collaborates with appropriate HELIOS application team or Subject Matter Experts (SME) to maintain the various table files for providing accurate CPT/HCPCS and revenue codes within EPIC which are responsible for providing accurate CPT/HCPCS codes and revenue codes based upon multiple payer requirements.

13. Adheres to HELIOS Service Level Agreements related to EPIC.

14. Analyzes legislation and regulations, reviews and interprets records, newsletters, bulletins, (billing and remittance) to comply with third party regulations. This includes knowledge of Medicare/Medicaid regulations as well as understanding of managed care contracts.

15. Actively participates in ongoing monitoring process to identify billing problems related to the CDM to include: evaluation of the accuracy of interface functionality, quarterly audit of the appropriateness of UB04 formatting for major payers and confirmation of the accuracy of departmental charge capture tools (charge screens, charge sheets, etc.).

16. Participates collaboratively with Revenue Integrity team in the development, execution and follow-up of education programs for Administration, Managers and Staff on all issues related to the charge master and charge master related processes.

17. Establishes and maintains effective working relationships with Nursing, Physicians, other Clinical Staff, Information Services, HIMS and PFS to facilitate expeditious resolution of coding and billing issues related to the functionality of the CDM file and related interface processes.

18. Participates actively in team development, achieving dashboards, and in accomplishing department goals and objectives.

19. Other duties as assigned.

Requirements

Qualifications:

• Bachelor's Degree.

Boston Services is an Equal Opportunity Employer and uses e-verify to check employment eligibility.