Company :Allegheny Health Network
Job Description :
The job maintains the integrity of the CDM (charge description master) and the software program and develops and implements policy's regarding CDM, pricing and fee schedule updates through a structure that promotes compliant operations throughout the Revenue Cycle continuum. The position performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues and questions relative to accounts receivable; acts a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met.
- Maintains the corporate standard CDM to ensure CDM files are coded and structured for correct coding guidelines, billing guidelines and compliance with third party payor rules, supporting AHN hospitals and physician practices. Leverages CDM Management tools to evaluate CDM through various compliance checks. (40%)
- Maintains hospital pricing and fee schedules associated with CDM, working within system policies and procedures. Works with internal department members and clinical departments and practices to create new CDM requests for items and pricing for new services. Assigns charge codes as requested by revenue producing clinical departments and practices. (25%)
- Participates in complete revenue cycle reviews involving the Charge Description Master and related audits with a focus on CDM management. Develops, implements and maintains CDM Management policies, procedures and training materials. (25%)
- Performs ad hoc consultative research and coordination on CDM issues, bed tables, preference list and accommodation updates. Executes on work plans to adapt systems and processes to accommodate changes, working closely with IT to achieve expected outcome. Provides ongoing guidance, training and support to practices and departmental Revenue Cycle staff. Works collaboratively with CFO's, department directors, RCO leadership, and health professionals to address ongoing CDM updates. (10%)
- Other duties as assigned.
- Bachelor's Degree in Business, Healthcare or related field OR Six (6) years of related, progressive experience
- 5 years with hospital or physician revenue cycle, billing, or coding experience
- 1 year in a Epic-CDM, billing environment
- CDM certification
- RN license
- A coding certification
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:$28.18
Pay Range Maximum:$43.80
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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