Revenue Integrity Chargemaster Analyst

Kootenai Hospital; Coeur d'Alene (ID); On-site; USD 85,000 - 105,000; Full time

Benefits offered by this job

Tuition assistance

Retirement plan with employer match

Competitive pay with shift differentia

Wellness program access

Job summary

Kootenai Health is seeking a Revenue Integrity professional to maintain the Chargemaster and CDM, ensuring pricing, codes and descriptions stay compliant with payer requirements. You will lead pricing reviews, coordinate with leadership, and publish annual updates to meet price transparency rules.

Responsibilities include CDM maintenance, cross-walk accuracy with clinical systems, and quarterly audits to ensure revenue integrity.

Qualifications

• Bachelor’s degree required; 6 years’ related Revenue Integrity experience may substitute for the degree.
• 2 years’ CDM (Chargemaster) experience preferred.
• Experience in hospital and professional revenue cycle operations and CMS regulations.
• Certification in coding (AAPC/AHIMA) preferred; knowledge of CPT/HCPCS and price transparency.

Responsibilities

• Owns charge description master development, maintenance, and reimbursement analysis.
• Reviews changes to the CDM and oversees others as needed.
• Ensures charge descriptions and billing codes are accurate in the Chargemaster.
• Leads strategy for compliant Chargemaster across software applications.
• Prepares for annual CPT/HCPCS updates and regulatory changes.

Skills

CDM experience

Revenue Integrity

CMS regulations

Epic EMR

Pricing analysis

Education

Bachelor's degree in related field

Tools

Epic EMR

Job description

Department Revenue Cycle - Revenue Integrity

Maintains the integrity of the Chargemaster and ensures all charging information including pricing, HCPCS/CPT codes and descriptions, and revenue codes are current and compliant with payer requirements. Ensures the CDM is built and maintained in accordance with government and industry regulations. In partnership with director and controller, acts as the organizations primary subject matter expert for the Chargemaster as it relates to annual pricing reviews, analysis, and pricing update recommendations, ensuring annual updates are published to maintain compliance with federal price transparency regulations.

Responsibilities

• Responsible for charge description master development, maintenance, and CDM comparative reimbursement analysis for hospital and professional charging across the organization
• Reviews and initiates all changes, additions, or deletions to the CDM, overseeing the work of others as necessary
• Ensures accuracy of clinical charges, descriptions and billing codes in the Chargemaster
• Leads hospital departments and IT staff in the formulation of a strategy for an efficient and compliant Chargemaster within all software applications
• Prepares the organization for timely implementation of annual coding updates (CPT, HCPCS), including modifier revisions and regulatory updates related to Chargemaster data
• Creates internal policies, procedures, tools, and forms for Chargemaster maintenance
• Compiles and analyzes clinical, competitor and payer charge and reimbursement data necessary to prepare recommendations advantageous to the company for pricing and charging, presenting recommendations to leadership as requested
• Regularly prepares CDM and payer reimbursement reporting, based on charge patterns and CDM change recommendations
• Monitors organizational charging and billing patterns and ensures accurate cross-walk of charge master details with underlying clinical systems used for charge capture and clinical documentation
• Conducts quarterly audits of the CDM to support accuracy and quality of hospital revenue
• Conducts periodic meetings with departments to analyze error reports, audit information and regulatory changes to assure continued accuracy of CDM. Facilitates meetings and documents questions, issues and follow-up tasks. Implements corrects and resolves outstanding issues, escalating to leadership as needed
• Monitors CDM maintenance for updates to assure compliance to price transparency
• Monitors compliance initiatives related to Chargemaster data, working closely with the Compliance Officer to monitor compliance investigatory activities and published findings, which may be correlated to Chargemaster billed data
• Develops pricing recommendations for new CDM items and services based on pricing research involving local peer group and other appropriate hospitals
• Ability to manage multiple priorities and to meet established project deadlines
• Performs other related duties as assigned
• Maintain high productivity and quality with minimal supervision
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• Bachelor’s degree in related field required; 6 years’ directly related experience in a Revenue Integrity role may be accepted in lieu of degree
• 2 years’ of responsible CDM (Chargemaster and fee schedule) experience preferred
• Experience in physician (professional) and hospital financial or revenue cycle operations required
• Coding certification from AAPC or AHIMA preferred
• Completion of medical terminology class preferred
• Experience collaborating in inter-disciplinary workgroups and building effective working relationship with all levels of staff and leadership
• Demonstrated knowledge of CMS regulations governing hospital and professional coding and billing required
• Experience working in an Epic or similar EMR with equivalent applications preferred
• Previous process improvement experience preferred

Working Conditions

• Must be able to maintain a sitting position
• Typical equipment used in an office job
• Repetitive movements

About Kootenai Health

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer‑paid options for eligible full‑time employees, plus affordable plans for part‑time staff.Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees
• Tuition assistance after 90 days to support your professional growth
• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%
• Competitive pay, plus night, weekend, and PRN shift differentials
• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps
• PerkSpot discountsproviding access to thousands of exclusive deals in over 25 categories
• And an employee referral bonus program

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

A variety of medical, dental, and vision insurance plans are available to both full and part-time employees, with some available at no cost to the employee. In addition, benefit-eligible employees also gain access to the following:

• Tuition assistance and career development programs
• Robust Retirement Plan
• Night, weekend and PRN shift differentials
• Employee referral bonus program

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