CDM Analyst - Remote - 137810

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

You can be part of the team responsible for building and maintaining charge master records for the health system. You'll ensure that chargemaster changes are processed promptly, accurately, and in compliance with Centers of Medicare & Medicaid Services (CMS), Medi-Cal, and other policies. You'll apply your extensive knowledge of billing, coding, and pricing practices, as well as data analysis skills, to monitor, maintain, and improve the charge master records.

Responsibilities:

• Assist with development and maintenance of charge codes and prices in partnership with Finance and Operations departments.
• Investigate and resolve charge records from work queues assigned to the Charge Description team.
• Conduct quarterly, annual, or as-needed reviews to ensure that the Charge Description Master is updated for new and revised CPT4/HCPCS codes while maintaining compliance with CMS, Medi-Cal, and health plan billing regulations.
• Comply with the Charge Master Department's policy and procedures related to charge codes and descriptions.
• Collaborate with the Revenue Integrity, Charge Reconciliation, Coding, and IS teams on the routine review of charge capture processes.
• Manages and conducts special project review that require analyzing complex billing/financial data including summarizing data and presenting findings to leadership.

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training. Related experience: Professional or Hospital Chargemaster experience, Revenue Integrity including charge structure and analysis, Professional and/or Hospital billing or finance including pricing strategies.

• Thorough knowledge of data analysis and CDM. Applies knowledge to identify deficiencies in financial documents and reports.

• Knowledge of CDM, medical center, and UC policies and processes. Thorough knowledge of relevant CDM federal, state and local laws and regulations to identify potential compliance risks.

• Strong technical skills to maintain CDM. Ability to produce high quality work and keep commitments. Productive in work volume, speed, quality and consistency.

• Proven ability to manage a project from inception to completion, while performing a wide variety of tasks, adapting to changing priorities, deadlines and directions.

• Interpersonal skills to maintain professional relationships with peers, multidisciplinary team members, and management.

• Strong skills to evaluate issues and identify solutions within defined procedures and policies.

• Verbal and written communication skills to explain technical concepts and articulate reasoning behind own opinions.

• Ability to perform all commonly applicable functions in word processing and spreadsheet software. Comprehensive knowledge of organization's CDM application programs to teach others.

• Strong teaching skills. Ability to break down complex concepts in an understandable way. Thorough knowledge of data management and documentation methods used in Charge Description.

• Epic PB or HB Charging Certification/Accreditation.

• Prior experience and/or knowledge of regulations on charging and billing practices for Medicare, Medi-Cal, and other payers (UB04 and/or CMS1500).

• Experience with EPIC charge master and familiarity with CDM structure, content, and maintenance, as well as in revenue integrity operations, clinical charge capture, or revenue cycle operations.

• Knowledge of CPT, HCPCS, and Medi-Cal coding guidelines and regulations; ability to utilize relevant reference resources (e.g., Federal Register, CMS memorandums, etc.).

• Proficiency in the use of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes.

• Understanding of compliance issues and their importance and consequences.

• Knowledge of EPIC system, particularly Resolute Hospital Billing and Resolute Professional Billing or SBO.

• Advanced knowledge of Microsoft Office, particularly Excel.

• Experience with project processes and facilitation of teams.

• Strong analytical, problem-solving, communication, interpersonal, and collaboration skills.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.