[Remote] Sr CDM Revenue Integrity Regulatory & Systems Analyst-24032

Note: The job is a remote job and is open to candidates in USA. Rush University Medical Center is seeking a Senior Revenue Integrity Regulatory & Systems Analyst on the CDM team to help translate complex healthcare regulations into accurate, compliant, and optimized charge capture across the organization. In this role, you’ll leverage deep expertise in coding, CDM, auditing, and Epic systems to solve complex charging scenarios, identify missed revenue opportunities, and drive automation and process improvements.ResponsibilitiesApply advanced understanding of regulations, NCD’s. LCD’s and payor concepts, along with revenue integrity concepts to make new and existing regulations actionable within the CDM, charge capture, data, and technology spaceServe as a liaison with compliance to promote and optimize accuracyResearches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursementProactively assess systems, processes, and audit revenue integrity output for accuracy and implements process improvement initiativesCoordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendationsMonitor Epic Revenue Integrity build to ensure alignment with regulations and charging rulesHarness the Epic and industry best-practices promote accurate automation to reduce manual laborUse logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, when applicableAnalyze revenue integrity denial trends and then provide actionable preventative measures for the Epic buildManipulate data along with identifying and translating trends into actionable remediesResponsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely mannerAssess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricingAudit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external auditsWorks with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accountsIdentify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed chargesServes as subject matter expert for fellow team members to review questions and assist with resolving accountsMeets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct managerCommunicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvementEngages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assignedSkillsAssociates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDMAAPC or AHIMA certificationEpic HB Certification within 6 monthsProficient and functional knowledge of reviewing charges in the Epic EHRAdvanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiersExcellent written and oral communication skills along with problem-solvingProficiency with MS Office SuiteHigh degree of accuracy and ability to collaborate with othersEpic Hospital Billing (HB) certificationBenefitsRush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).Company OverviewRush University Medical Center offers healthcare services for children and adults, clinical trials, medical education and training services. It was founded in 1837, and is headquartered in Chicago, Illinois, USA, with a workforce of 10001+ employees. Its website is https://www.rush.edu/.