Senior Revenue Integrity Analyst

Children's National Medical Center; Silver Spring (MD); On-site; USD 78,000 - 129,000; Full time

Job summary

Children's National Medical Center in Silver Spring, MD seeks a Senior Revenue Integrity Analyst to oversee charge workflows, ensure compliant billing practices, and resolve system/charging issues across hospital and professional services.

The role requires 4+ years in charge capture or related fields, a relevant Associate's or Bachelor’s degree, and CPC/COC certification is preferred. Strong analytical and communication skills are essential for cross-functional collaboration.

Qualifications

• Demonstrates excellent organizational and problem solving skills.
• Ability to delegate assignments and follow through on details is essential.
• Excellent internal and external customer service skills required.
• Must possess ability to be effective and efficient in a fast paced environment, managing multiple competing tasks and priorities.

Responsibilities

• Validate and approve access to all charge workflows and charge corrections, as directed by the CDM Supervisor.
• Provide education and in-service training to departments in collaboration with CDM Supervisor
• Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.
• Process complex CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner.
• Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments, including review of supplies, lab charges and pharmacy charges.
• Analyze data within the CDM and assign accurate CPT/HCPCS and revenue codes to the Charge Master to insure compliance with regulatory guidance, per Billing and Coding industry norms.

Skills

Organizational skills

Problem solving

Customer service

Multitasking

Education

Associate's Degree

Bachelor's Degree Healthcare related field

Job description

12211 Plum Orchard DriveSilver Spring, MD 20904

Kids Are Our Everything.

Department

Revenue Integrity

Pay Range

$77,584.00 - $129,292.80

The Senior Revenue Integrity Analyst will report to the Revenue Integrity Supervisor and demonstrate expertise in charge workflows, billing compliance and charge analysis in the pediatric medical setting. The Senior Revenue Integrity Analyst will review, analyze, charge workflows and pricing model/logic for either technical and/or professional services to support compliant billing practices. The Senior Revenue Integrity Analyst will discover possible system/Charging issues for resolution. Will support Revenue Integrity Supervisor with pricing tools, charge workflow changes and support the testing of charge capture workflows for new locations and service lines. The Sr Revenue Integrity Analyst function will ensure compliance with established charging guidelines, third party reimbursement policies, CMS regulations and accreditation guidelines.

Minimum Education

Associate's Degree Relevant experience beyond the minimum required work experience may substitute the educational requirement on a 1-to-1 ratio. (i.e., one year of relevant work experience equals one year of required education). (Required)

Bachelor's Degree Healthcare related field (Preferred)

Minimum Work Experience

4 years Experience in charge capture, coding or charge description master in a hospital environment for hospital and professional services. (Required)

Required Skills/Knowledge

• Demonstrates excellent organizational and problem solving skills.
• Ability to delegate assignments and follow through on details is essential.
• Excellent internal and external customer service skills required.
• Must possess ability to be effective and efficient in a fast paced environment, managing multiple competing tasks and priorities.

Required Licenses and Certifications

COC/CPC Coding Certification (Preferred)

Functional Accountabilities

Department Strategic Planning

• Validate and approve access to all charge workflows and charge corrections, as directed by the CDM Supervisor.
• Provide education and in-service training to departments in collaboration with CDM Supervisor
• Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.
• Process complex CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner.
• Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments, including review of supplies, lab charges and pharmacy charges.
• Analyze data within the CDM and assign accurate CPT/HCPCS and revenue codes to the Charge Master to insure compliance with regulatory guidance, per Billing and Coding industry norms.
• Distribute coding and billing regulatory requirements and/or announcements to all applicable departments.
• Responsible to make CDM related decisions that require significant analysis and investigation.
• Assist with developing and maintaining policies and procedures for the CDM, Pricing Policies and charge capture processes.

Program and Service Administration and Implementation

• Perform all maintenance to the Charge Description and Service Master and the Room and Bed Master Files
• Create and maintain all hospital transaction codes and revenue department codes.
• Monitor and report all revenue department's charge volumes and posting lag days.
• Research and resolve all charge and service master related code errors that affect the recycle and reject reports.
• Assist in performing comprehensive reviews with clinical departments to ensure completeness and accuracy of charge description master.
• Take initiative to identify system and/or operational problems and participate in the development of solutions to improve billing functions.

Human Resources and Relationship Management

• Serve as expert resource for code and processing questions, train and educate coders.
• Maintain relationships with, and serve as liaison to department administration, physicians, clinic administration, information services, billing offices, financial offices and other departments.
• Participate in team meetings/activities and support the philosophy and goals of the team and department.
• Provide individual feedback and goal setting recommendations as directed by the Sr Manager
• Adhere to internal controls and reporting structure.
• Remain current with updated coding and billing regulations through yearly continuing education; read all announcements and relevant communications that relate to job duties.
• Lead special projects/assignments as directed by the CDM Supervisor.

The disclosed salary range includes the minimum and maximum rates within which Children's National believes an individual's base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children's National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual's combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children's National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The "Know Your Rights" poster is available here: and the pay transparency policy is available here:Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a "drug-free" work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.