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Revenue Cycle Analyst

2 months ago

Allentown, Pennsylvania, United States St. Luke's Hospital Full time
Job Summary

St. Luke's Hospital is seeking a highly skilled Revenue Cycle Analyst - CDM Specialist to join our team. As a key member of our revenue cycle operations team, you will play a critical role in ensuring the accuracy and compliance of our Charge Description Master (CDM) with third-party payer regulations and requirements.

Key Responsibilities
  • CDM Maintenance and Updates: Assist in the maintenance and updating of the network CDM under the direct supervision of senior level staff members, ensuring that all hospital services are added to the CDM per established policies and procedures.
  • Network Audit/Review Initiatives: Participate in network audit/review initiatives to ensure compliance with third-party payer regulations and requirements related to the charge process.
  • Payment Verification: Verify the accuracy of payments received for services rendered per third-party payer contracts/other payment protocols.
  • Charge Establishment: Assist management in the establishment of charges for new procedures, services, and supplies.
  • Initial Pricing: Responsible for the initial pricing of hospital and professional services utilizing various pricing methodologies established for the Network.
  • CDM Compliance: Ensure that the CDM complies with third-party coding requirements regarding UB04 revenue codes, HCPCS/CPT codes.
  • Customer Service: Field customer service requests to ensure patient chart documentation supports the charges applied to the patient account.
  • Outpatient Workers Compensation Fee Schedules: Update Outpatient Workers Compensation Fee Schedules on a quarterly basis.
  • Third-Party Correspondence: Review third-party correspondence (bulletins, Code Correct Informants, etc.) to identify possible additions and/or revisions to CDM/Epic system.
  • Policies and Procedures: Comply with all hospital and departmental policies and/or procedures.
  • Confidentiality: Maintain confidentiality of all materials handled within the Network/Entity as well as the proper release of information.
Requirements
  • Education: Four-year degree in health administration, business, or related field is preferred.
  • Experience: Two years of CDM maintenance experience is preferred.