Revenue Integrity Chargemaster Analyst

About the Organization

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research, and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. The hospital is ranked in all 10 specialties by U.S. News & World Report.

About the Role

The Revenue Integrity Chargemaster Analyst is responsible for maintaining the integrity of the revenue capture system for the organization. Maintaining an accurate and compliant charge capture system is critical to the fiscal strength of the organization. The role conducts prospective audits of patient charts to ensure billing accuracy.

Responsibilities

• Oversees maintenance of the chargemaster (CDM). Reviews, approves, and builds all new charges, including CPT (Current Procedural Terminology) codes, HCPCS codes, pricing, revenue codes, and appropriate usage.
• Ensures all charges are tested and fully integrated with other systems, such as supply systems and department preference lists.
• Updates the CDM annually based on changes published by the AMA via CPT guidelines and quarterly based on CMS guidelines for HCPCS codes.
• Acts as the primary liaison to clinical departments for annual CPT/HCPCS updates and ad hoc changes. Collaborates with Information Management to ensure new and deleted codes are implemented appropriately.
• Serves as a resource to revenue generation departments for establishing new charges or addressing questions about existing charges. Develops coding education for internal departments.
• Oversees billing edit processes, including CCI and MUE, along with other revenue capture initiatives captured by edits. Collaborates with departments to reduce pre-bill edits and achieve clean claims.
• Tracks edit volumes by type and department to identify and assist with resolutions as necessary.
• Reviews CDM departments regularly or as defined in the Revenue Integrity Workplan, including accuracy of charge use, review of charges available, charge reconciliation, and identifying opportunities and deficiencies.
• Works with a multidisciplinary committee to oversee and implement the annual price increase for the organization. Ensures all fee schedules are updated accurately, which may include working with consultants and department leadership.
• Collaborates with all levels in the organization regarding opportunities and/or deficiencies. Provides recommendations for improvement and education as necessary. Performs follow-up reviews to ensure implementation of improvements.
• Develops corrective action plans and participates in compliance investigations as needed.
• Assists with the annual Revenue Integrity Workplan development and ensures adherence to the workplan.
• Maintains an understanding of current Medicare, Medicaid, and commercial payer billing regulations and implements changes as related to CDM.
• Develops an understanding of charge triggering systems used throughout the organization.
• Participates in projects, committees, and system upgrades as necessary.
• Performs job functions adhering to service principles with a customer service focus of innovation, service excellence, and teamwork.
• Performs other job functions as assigned.

Requirements

• Bachelor’s degree required; master’s degree preferred. Appropriate experience and/or training may be accepted in lieu of educational requirements.
• Coding credential required within 6 months of employment. Accepted credentials include:
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Coding Specialist (CCS)
  • Certified Coding Associate (CCA)
  • Certified Coding Specialist – Physician Based (CCS-P)
• Clinical discipline preferred.
• 3 years of CDM experience required.
• Epic CDM experience preferred.
• Epic Certification in Charge Capture required within one year.

Skills

• Strong analytical and financial skills.
• Proficient with Microsoft Office: Excel, Word, and PowerPoint.
• Strong verbal and written communication skills.
• Working knowledge of clinical operations in a complex academic environment.
• Strong research skills and the ability to understand and interpret billing and documentation regulations.
• Ability to work independently and creatively.
• Maintains independence, objectivity, and professional skepticism.
• Comfortable using computers, including the EMR.
• Knowledge of billing processes used in healthcare organizations.

Pay

The pay range for this position is $65,520.00 - $107,120.00. At Lurie Children’s, compensation is aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. In addition to base salary, the organization offers a comprehensive rewards package, including differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs.

Benefits

For full-time and part-time employees who work 20 or more hours per week, Lurie Children’s offers a generous benefits package that includes:

• Medical, dental, and vision insurance.
• Employer-paid group term life and disability insurance.
• Employer contribution toward Health Savings Account.
• Flexible Spending Accounts.
• Paid Time Off (PTO), paid holidays, and paid parental leave.
• 403(b) retirement plan with a 5% employer match.
• Various voluntary benefits, including:
  • Supplemental life, AD&D, and disability insurance.
  • Critical illness, accident, and hospital indemnity coverage.
• Tuition assistance and student loan servicing and support.
• Adoption benefits.
• Backup childcare and eldercare.
• Employee Assistance Program and other specialized behavioral health services and resources for employees and family members.
• Discount on services at Lurie Children’s facilities.
• Discount purchasing program.