Sr CDM Revenue Integrity Regulatory & Systems Analyst

Location: Chicago, IllinoisBusiness Unit: Rush Medical CenterHospital: Rush University Medical CenterDepartment: Revenue Cycle Revenue IntegritWork Type: Full Time (Total FTE between 0.9 and 1.0)Shift: Shift 1Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).Pay Range: $38.02 - $61.88 per hourRush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.Summary:Rush is seeking a Senior Revenue Integrity Regulatory & Systems Analyst on the CDM team to help translate complex healthcare regulations into accurate, compliant, and optimized charge capture across the organization. In this role, you'll leverage deep expertise in coding, CDM, auditing, and Epic systems to solve complex charging scenarios, identify missed revenue opportunities, and drive automation and process improvements.You'll partner closely with compliance, operational teams, and fellow revenue integrity professionals, serving as a subject matter expert while helping improve workflows, strengthen system builds, and support accurate reimbursement. This is an excellent opportunity for someone who enjoys working at the intersection of regulation, technology, and data to make a meaningful impact in a highly collaborative healthcare environment.The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.Responsibilities:Apply advanced understanding of regulations, NCD's. LCD's and payor concepts, along with revenue integrity concepts to make new and existing regulations actionable within the CDM, charge capture, data, and technology spaceServe as a liaison with compliance to promote and optimize accuracyResearches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursementProactively assess systems, processes, and audit revenue integrity output for accuracy and implements process improvement initiativesCoordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendationsMonitor Epic Revenue Integrity build to ensure alignment with regulations and charging rulesHarness the Epic and industry best-practices promote accurate automation to reduce manual laborUse logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, when applicableAnalyze revenue integrity denial trends and then provide actionable preventative measures for the Epic buildManipulate data along with identifying and translating trends into actionable remediesResponsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely mannerAssess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricingAudit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external auditsWorks with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accountsIdentify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed chargesServes as subject matter expert for fellow team members to review questions and assist with resolving accountsMeets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct managerCommunicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvementEngages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assignedRequired Job Qualifications:Associates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDM.AAPC or AHIMA certificationEpic HB Certification within 6 monthsProficient and functional knowledge of reviewing charges in the Epic EHR.Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiersExcellent written and oral communication skills along with problem-solvingProficiency with MS Office SuiteHigh degree of accuracy and ability to collaborate with othersDesired Qualification(s)* Epic Hospital Billing (HB) certification.Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.