Charge Description Master Process Analyst

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Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

As a Charge Description Master (CDM) Analyst, you're responsible for ensuring the accuracy, integrity, and upkeep of the facility Charge Description Master and physician practice fee schedules, working daily with the hospital pharmacy formulary and supply chain item master. We seek a resourceful, detail-oriented professional with strong research skills who can work independently, shift priorities smoothly in a fast-paced environment, and manage multiple tasks while delivering accurate, timely results; and also understand reimbursement and denial management. Excellent communication, problem-solving ability, and a commitment to quality are essential; experience with CDM management, fee schedules, pharmacy formulary, or supply chain item master is preferred.

Work Environment & Flexibility

Mostly Remote (Monday-Friday; 8am-5pm) for optimal work-life balance
Onsite requirements: Quarterly onsite meetings with team required at CHOP- to inspire teamwork by bringing the group together to plan boldly, connect meaningfully, and innovate for lasting impact.

Apply today and help strengthen the financial health of our hospital system-while enjoying the flexibility of a fully remote role.

What you will do

• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payor needs.
• Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with the RI Specialist and their revenue producing departments to ensure the ongoing coordinated consistency of the charge master and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Work with analysts to perform applicable analyses to understand net revenue effect of proposed charge master and fee schedule changes.
• Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
• Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims. Assists in researching coding issues and recommends solution to account representative. Identifies source of problem and works with analysts to implement corrective actions to ensure that the charge master is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement.
• Assist in strategic pricing process to optimize reimbursement within budget guidelines.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.
• Performs other duties as assigned.

Education Qualifications

• Associate's Degree Business, Healthcare or related field Required
• Bachelor's Degree Business, Healthcare or related field Preferred

Experience Qualifications

• At least three (3) years Hospital or physician revenue cycle, billing, or coding Required
• At least five (5) years Experience with coding, billing and CDM maintenance Preferred

Skills and Abilities

• Business Skills: Knowledge of healthcare revenue cycle functions, and billing and collection processes specific to the charge master. (Required proficiency)
• Regulatory: Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claim forms. (Required proficiency)
• Business Analytics: Identifies data and analytic challenges including data integrity, appropriateness of data sample, context and consistency between sources. Fully leverages power of analytic tools (Required proficiency)
• Collaboration: Experience supporting RI initiatives specific to implementation, and/or major process improvement and redesign. (Required proficiency)
• Facilitator: Plans effectively yet is fluid based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener. Experience with coding, billing and CDM maintenance (Required proficiency)

Licenses and Certifications

• Certified Outpatient Coder (CPC-H) - American Academy of Professional Coders (AAPC) - within 12 months - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.