What are the responsibilities and job description for the CHARGE MASTER ANALYST - Health Information Dept (HIM) - Full Time - Days - Onsite position at Sierra View Medical Center?
Charge Master Analyst - Full Time
Shift: 8:00am - 4:30pm
NOTE THIS IS AN ONSITE POSITION - NOT REMOTE.
Job Description:
PATIENT POPULATION:
The patient population served can be all patients including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.
POSITION SUMMARY:
Reporting to the Department Leader, the Charge Master Analyst is responsible for maintaining and optimizing the hospital's Charge Description Master (CDM) to ensure accurate, compliant, and complete charge capture and pricing across all inpatient, hospital-based outpatient, and ambulatory service areas. The CDM Analyst serves as a subject matter expert and liaison between clinical departments, Coding, Billing, Compliance, Finance, IT, and Materials Management to support correct charging, appropriate reimbursement, and adherence to regulatory and payer requirements.
Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.
(Gov’t. Code §§ 3100, 3102)
Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct.
The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate a cooperative behavior with colleagues and supervisors.
EDUCATION/TRAINING/EXPERIENCE:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
To perform this job successfully, an individual must have a minimum of 3-5 years of experience in hospital revenue cycle, chargemaster maintenance, coding, billing, patient accounting, or revenue integrity. Prior hands-on experience with CDM Management or charge capture strongly preferred. Experience working with reimbursement methodologies (Medicare OPPS, APCs, DRGs), and payer billing requirements.
Demonstrated knowledge of federal and state billing requirements and compliance issues.
The individual is self-directed and demonstrates ability to work independently with little or no supervision. The individual will also possess advanced critical thinking and problem solving skills.
Ability to read and interpret documents such as Federal and State (Medicare and Medi-Cal) bulletins, notices, and official documents, and apply changes to the Chargemaster and charging processes as appropriate. Ability to write routine reports and correspondence if required. Effective oral and written communications are integral to the position.
Clear, accurate and detailed documentation of policy and process changes, training guides, major system changes, etc. for historical reference is a requirement.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Requires significant capacity to manage multiple competing objectives and to communicate complex technical information in understandable terms to management and other personnel of Sierra View Medical Center.
LICENSURE/CERTIFICATIONS:
N/A
Responsibilities and Essential Functions:
- Indicates Essential Function
1 * Maintain the CDM, including the creation, modification, inactivation, and deletion of CDM line items. Ensure each charge has appropriate CPT/HCPCS, modifiers, revenue code, description, pricing, units, and any required flags or indicators. Coordinate routine and ad hoc CDM reviews with departments, tracking requested changes form intake through approval and implementation in coordination with the Revenue Cycle Lead. Maintain documentation of CDM Change requests, approvals, effective dates, and related system updates.
2 * Validate CPT/HCPCS, revenue codes, and modifiers for CDM items to ensure compliance with CMS, Medicare OPPS, Medi-Cal, commercial payer, and NCCI/OCE edit requirements. Monitor coding, billing and regulatory updates; assess impact on the CDM and implement required changes in collaboration with the Revenue Cycle Lead in a timely manner. Partner the Revenue Cycle Lead and Coding/CDI Lead to research and resolve charging or coding discrepancies, denials, and audit findings related to CDM configuration.
3 * Assist Finance in routine pricing reviews, including benchmarking against Medicare Reimbursement, market data, and organizational pricing strategy. Identify underpriced, unbilled, or misaligned charges and recommend appropriate pricing or structural changes. Analyze charge and reimbursement patterns to identify missed revenue opportunities, undercharging, and inappropriate use of non-covered or redundant charge lines.
4 * Serve as the primary resource for departments regarding charge build, charge options, and CDM-related questions. Work with clinical leaders (i.e. surgery, Imaging, Laboratory, ED, clinics) to ensure available charge codes accurately reflect services and supplies provided. Participate in multidisciplinary workgroups and projects related to new services, supplies, technology implementations, and service line expansions.
5 * Coordinate with the Revenue Cycle Lead to ensure CDM entries are properly mapped to order entry, templates, preference lists, and billing system charge records. Test and validate CDM-related system changes, upgrades, and new builds to confirm accurate charging and claim generation. Monitor charge edit work queues, unbilled accounts, and recurring charge errors to identify build or mapping issues; implement corrective actions. Perform periodic audits and data quality reviews of charge activity to verify that CDM configuration supports accurate and timely billing.
6 Performs other duties as assigned by the Department Leader.