Revenue Integrity and Chargemaster Analyst

Job Description:

Job Description

The Revenue Integrity and CDM Analyst is responsible for the development, implementation, and maintenance of the UT Health San Antonio Multispecialty and Research Hospital (MSRH) CDM and is responsible for accurate and timely payments from third party payers in compliance with managed care contracts and government fee schedules.. The Revenue Integrity and CDM Analyst will be responsible for ensuring accurate, up-to-date, and compliant coding and pricing of medical services, procedures, and supplies. This role prepares relevant reports for management review. They will analyze third party denials and prepare relevant reports regarding trends in denials. They will determine root causes of denials and work with the appropriate departments to establish processes to ensure prevention of the denials. The Revenue Integrity and CDM Analyst will develop, produce, validate and distribute standard management and ad-hoc reports as requested by end-users. This position will obtain, manipulate and analyze data from a variety of sources. This role requires a strong understanding of healthcare reimbursement methodologies, compliance standards, and a commitment to maintaining the highest level of data integrity. The Revenue Integrity and CDM Analyst reports directly to the MSRH Director of Revenue Cycle, but collaborates with various departments, including finance, revenue cycle, coding, compliance, and clinical units, to optimize revenue capture and enhance financial performance.

Responsibilities

• Create and maintain the CDM, including the assignment of accurate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and other relevant codes for clinical services and supplies. 
• Regularly update the CDM with new codes, price changes, and revisions, ensuring alignment with the latest industry standards and guidelines. 
• Conduct regular audits to verify data accuracy and completeness within the CDM. 
• Monitor and adhere to all relevant regulations, guidelines, and payer requirements related to charge capture, billing, and coding. 
• Collaborate with compliance officers and other stakeholders to ensure the organization’s adherence to healthcare regulations and mitigate compliance risks. 
• Analyze reimbursement trends and identify opportunities to optimize revenue capture, minimize denials, and improve revenue cycle performance. 
• Recommend pricing strategies to align with market trends and ensure competitive positioning. 
• Collaborate with clinical departments to obtain accurate and comprehensive information on services and procedures for proper coding and pricing. 
• Work closely with the finance and revenue cycle teams to provide insights and support related to charge capture, billing, and reimbursement processes. 
• Train and educate relevant staff members on coding, billing, and charge capture best practices to maintain compliance and improve overall accuracy. 
• Stay updated on industry changes, trends, and best practices, and share knowledge with team members. 
• Generate and present regular reports on key performance indicators related to charge capture, coding accuracy, and revenue trends to management and other system stakeholders. 
• Research, identify and analyze the impact of potential process changes after completion of root cause analysis of denials. 
• Prepare and distribute monthly adjustment reports to clinical areas for continued education 
• Prepare and distribute monthly denials reports to specific clinical areas for follow up.

Qualifications

• Proficiency in medical coding systems such as CPT, HCPCS, and ICD-10, with a deep understanding of coding principles and guidelines. 
• Knowledge of healthcare reimbursement methodologies, payer requirements (Medicare, Texas Medicaid, non-government managed care payers), and compliance regulations (e.g., CMS, HIPAA). 
• Direct experience with charge capture and billing systems (preferably Epic) and the ability to analyze and interpret complex data. 
• Excellent analytical and problem-solving skills with an eye for detail and accuracy. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams (including clinical units). 
• Demonstrated ability to lead, train, and mentor staff in charge capture and coding processes.

EDUCATION:

• Bachelor’s degree in healthcare administration, business administration, finance, audit, or related field required; although, a combination of relevant education and experience may be considered.

EXPERIENCE:

• Minimum of 5 years of experience in healthcare revenue cycle management, facility CDM maintenance, revenue integrity or related roles.

LICENSE/CERTIFICATIONS:

• Coding certification CPC or CSS credentials preferred
• Resolute Hospital Billing Charging Certificate preferred
• Certifications in Healthcare Finance, Revenue Cycle, and/or Patient Access Issued from industry standard bodies, such as HFMA or MGMA or AAPC preferred