Analyst – RCM (RCM Coder)

Job purpose: 

Oversees the integrity of the Charge Description Master (CDM) and maintains responsibility for updates to charge codes within the CDM. The Analyst monitors quality and key metrics to ensure all activities are being completed by the CDM team in a timely and accurate manner. Oversees daily maintenance, regular updates, and price impact analyses and facilitates all changes implemented in the CDM. Works closely with the Revenue Cycle Management Team to ensure accurate and timely charging, recommend process improvements, and maximize gross revenue. This role would be designing, building and supporting Patient Access Solutions for registration, scheduling, revenue cycle management, and the patient portal.

Main tasks and responsibilities (the position exist to perform the below tasks and essential activities)

Oversee processing of CDM requests to ensure that all additions, changes, and deletions are consistent with proper charging, billing, coding, and pricing practices in a timely manner.

Facilitate analysis of the CDM to ensure accurate assignment of CPT and revenue codes to the Charge Master to comply with regulatory practices.

Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.

Manage, prepare and review monthly reporting metrics for internal and external stakeholders

Identifies issues and conducts analysis and/or audits (i.e., gap analysis, audit summary) of payer and/or client issues and escalations.

Manage and oversee payer and patient revenue cycle management processes for various hospital specialty accounts

Conducts trending on baseline metrics (billing, collection, and remittance) and assist with the development and resolution of action plans

Analyze insurance denial trends and create front end edits/rules to help increase clean claim rates and reduce denial rates.

Create and track payer project plans associated with accounts receivable, including communication with payer representatives to initiate claims projects.

Maintain archive of process, policy, and training documents.

Monitor and document payer updates to enhance the billing system or enhance scrubs/edits and reduce denials

Provide weekly status reports on projects to the Manager – RCM.

Respond to Customer Care Center questions and cases and/or escalate as needed.

Perform audits to identify opportunities to drive improvement

Manage multiple tasks and deadlines with minimal oversight

Participate in strategic planning sessions

Perform any manual or specialized billing needs as required

Facilitate charge router logic review with Revenue Integrity and Coding counterparts to ensure accurate assignment of charges for services performed.

Develop and maintain policies and procedures for CDM maintenance, pricing updates, and charge capture processes

Facilitate charge router logic review with Revenue Integrity and Coding counterparts to ensure accurate assignment of charges for services performed in coordination with the Manager – RCM.

Conduct annual review of the CDM and quarterly updates as appropriate.

Ensure to provide excellent customer service to departments and respond in a timely manner to all charge inquiries, updates, and requests for charge form set-up and assistance.

Maintain excellent relationships with, and serve as liaison among RCM Team, Health System departments, and Finance team.

Identify new coding sequences, as needed, for new services.

Evaluate recommended charge protocols for given procedures in conjunction with reimbursement.

Experience Knowledge and Skills

Bachelor’s degree in business, Commerce, Health Information Management or Finance (Essential)

Minimum 2 years’ experience with data analytics (required)

Minimum 2 years in GCC (preferred)

Proficient in all Microsoft Office applications as well as medical office software.

Proven experience in healthcare billing.

Sound knowledge of health insurance providers.

Deep knowledge of Revenue Cycle Management within Billing, Collections, and Remittance posting.

The ability to work in a fast-paced environment.

Billing/Coding certification(s) preferred but not required

Knowledge of payer websites, processes, local, state, and federal requirements