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Bozeman Health · 2 months ago

Revenue Integrity and Chargemaster Analyst (FT- 1.0 FTE, Day Shift, Remote)

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

Bozeman Health is a healthcare organization seeking a Revenue Integrity and Chargemaster Analyst to maintain the integrity of the Charge Description Master and support accurate charge capture processes. The role involves collaboration with various departments to ensure compliance with payer requirements and regulatory standards while conducting audits and analysis to optimize revenue.

Health CareHospitalMedical

Responsibilities

Maintain the Charge Description Master (CDM), ensuring all CPT/HCPCS codes, revenue codes, pricing, modifiers, and descriptions are accurate and updated based on quarterly and annual regulatory changes

Collaborate with clinical departments and service line leaders to evaluate requests for new charge codes, price changes, or service modifications

Conduct ongoing charge capture audits to identify missed charges, billing errors, and compliance risks; escalate findings and partner with departments on corrective actions and prevention

Review and interpret payer guidelines, National Correct Coding Initiative (NCCI) edits, Medically Unlikely Edits (MUEs), OPPS regulations, and Medicare/Medicaid bulletins to ensure a compliant charge structure

Support the implementation of new services or technologies by facilitating charge build, revenue code assignment, and mapping to billing workflows

Provide analytical support for revenue variance investigations, reimbursement trends, charge validation, and payer audit responses; summarize and present findings to stakeholders

Assist in validating the accuracy of chargemaster pricing relative to CMS fee schedules, organizational pricing strategies, and applicable price transparency requirements

Participate in revenue cycle performance improvement initiatives related to charge capture, reconciliation, and clean claim submission; document root causes and monitor outcomes

Collaborate with IT and billing teams to test charge router rules, EAP builds, and fee schedule updates within the billing system

Maintain clear, organized records of CDM changes, audit findings, and billing guidance to support accuracy, compliance, and audit readiness

Educate departments and end users on charge capture requirements, documentation standards, and changes affecting charging, coding, and billing

Participate in or support cross functional revenue integrity/charge governance meetings and committees

Qualification

Revenue integrityCDM maintenanceCPTHCPCS knowledgeEPIC billing systemHealthcare billing principlesBilling requirements for OPPSProfessional certificationAnalytical skillsCommunication skillsInterpersonal skills

Required

Associate's Degree; or an equivalent combination of education and experience may be considered

Two (2) years of experience in revenue integrity, CDM maintenance, coding, or billing

Advanced understanding of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), revenue codes, modifiers, and healthcare billing principles

Intermediate knowledge of EPIC billing system, charge capture tools, and regulatory resources (e.g., Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), Outpatient Prospective Payment System (OPPS))

Intermediate knowledge of billing requirements for OPPS, Critical Access Hospital (CAH), and Prospective Payment System (PPS) settings, including Uniform Billing Form (UB-04) and CMS guidelines for hospital billing (HB), professional billing (PB), and provider-based billing (PBB)

Preferred

Bachelor's Degree in Health Information Management, Business, Finance, or a related field

Four (4) years of experience in revenue integrity, CDM maintenance, coding, or billing

Prior experience in a hospital or health system

Professional certification such as Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Revenue Cycle Representative (CRCR), or Certification in Healthcare Revenue Integrity (CHRI)

Experience with Epic Resolute HB/PB charge build (EAP records), charge router rules, and fee schedule maintenance

Experience supporting internal or external payer audits and implementing corrective action plans