Senior CDM Analyst
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 5,000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation's 20 leading cancer centers that develops and institutes standards of care for cancer treatment.
CDM Analyst is responsible for ensuring the City of Hope Charge Description Master (CDM) and processes are in compliance with Federal/State guidelines, while ensuring that the CDM is accurately reflecting all line items correctly for billing to payors and patients.
CDM Analyst has overall responsibility for maintenance of CDM items and works in coordination with Government Reimbursement, Information Services, Business Office, Health Information Services and clinical departments. CDM Analyst works collaboratively with Revenue Integrity staff in the development, execution, and follow up education to City of Hope staff.
- Maintains integrity of data collected including but not limited to: City of Hope CDM extracts and reports produced by CDM software and ad hoc reports using macros/other data collection methods
- Ensures that coding, revenue codes, description nomenclature, patient billable vs. non-billable, catalog development and updates (add/delete/change) for all CDM items are appropriate, verified through monthly feedback from Revenue Cycle leadership
- Conducts Epic pre-workmapping exercise to identify issues well in advance of actual Was/Is mapping from legacy to Epic CDM
- Performs initial Was/Is mapping of legacy CDM to Epic CDM. Performs subsequent monthly review of legacy CDM extracts for updates to the Epic environment for additions, deletions and modifications
- Performs ad hoc reporting as requested; participates in special projects/reviews as needed; creates and maintains templates and macros for Compliance, affiliates, Finance and other departments
- Creates and maintains macros to obtain daily Epic CDM extract from Craneware and posts to the CDM portal site
- Produces monthly Accounts Receivable reports for hospitals and medical foundations
- Serves as the primary contact for receiving CDM data downloads; monitoring timely submission as required by the CDM Department Policy
- Produces affiliate specific CDM Progress Measure reports to indicate discrepancies between affiliate charge masters and COH standards
- Maintains a master summary, by affiliate, of CDM maintenance standards and statistics and initiates discussion with CDM Director identifying areas of concern, trends in data omissions and other findings in maintenance reports
- Merges CDM extracts into Craneware and reports on a monthly basis to hospital affiliates,quarterly to medical foundations, and to other entities based on other designated timelines for submission
- Facilitates effective ongoing CDM management and maintenance by acting as primary technical support for all CDM Department databases and software
- Coordinates with other Revenue Cycle staff on quarterly/annual department CPT/HCPCS coding and CDM maintenance updates to coincide with the CMS annual updates to the Hospital Outpatient Prospective Payment System.
- Establish and maintain effective working relationships with clinical, Information Services, HIMS and Patient Business Office to facilitate expeditious resolution of coding and billing issues related to the functionality of the CDM file and related interface processes that causes delays in submission of the download data
- Works to resolves CDM software issues with vendors and maintains an issues log
- Assists in evaluating software upgrades/replacement software
- Educates end users about data elements in the data downloads to ensure that requests are understood and results are achieved
- Assists in implementing regulatory and other changes to the CDM in a timely manner
- Acts as the point of contact for issues and maintains user list for access to the CDM software
- Acts as initial point of contact for end users to gain access to the Emergency Department software for charging; receives quarterly Benchmark Analytic Reports and places these documents on the CDM shared drive for access; provides notification of pricing updates to Emergency Department levels and services; periodically produces report of Emergency Department level distribution across the system as requested
- Acts as primary owner of the CDM portal site
- Ensure annual CDM Pricing is updated and implemented
- Assist in the review of pricing for individual line items and maintain the pricing files as changes occur. Maintain the pricing files for mark-ups based in accordance with organizational policy.
- Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication across the enterprise.
- Maintains personal professional growth and development through seminars, workshops and professional affiliations.
- Service quality and work quality to meet required COH, state and federal rules and regulations.
- Ensures that compliance to rules, regulations, operations, contracts, internal and external rules, state and federal requirements are met.
- Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, includingadherence to theworkplaceCode of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality
- Bachelor's degree required. Bachelor of Science, Bachelor of Arts, Registered Nurse with BS or BA. Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT) certification can be in lieu of degree.
- Five (5) or more years relevant experience in a hospital setting, healthcare system, working with a hospital and professional Charge Description Master
- Active certification as a Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P) from the American Health Information Management Association
- Minimum seven (7) or more years relevant experience in a hospital setting, healthcare system, working with a hospital and professional Charge Description Master
- Experience in EPIC preferred. Experience with Craneware (CDM Master, Pricing, Pharmacy Tool) preferred
- Extensive knowledge in revenue cycle processed. Ability to interface with all levels of the organization effectively. Experience manipulating the underlying IT infrastructure to achieve outcome goals. Incorporating regulatory requirements and performing data input and analysis and QA. Extensive experience in effective problem solving skills, project management skills, and conflict resolutions skills. Demonstrated proficiency in MS Office Suite, especially Microsoft Excel as well as PowerPoint and Word. Ability to travel to main campus regularly/as needed.
City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
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