Revenue Cycle Integrity

Megan Clauss

Ponte Vedra, FL 407-***-**** ********@*********.*** Linkedin: megan-clauss-637995156

REVENUE INTEGRITY ANALYST CHARGE MASTER ANALYST

PROFESSIONAL SUMMARY

Dedicated Revenue Integrity Analyst with over 7+ years of experience in healthcare revenue cycle management, specializing in Charge

Master, pre-bill audit analysis, and revenue integrity trends and root cause analysis.. Holds a Bachelor’s degree in Health Science from the University of Florida, complemented by certifications in CRCR and EPIC HB Certification. . Known for strong leadership, exceptional ability to take initiative and proven track record in improving billing processes and ensuring accurate charge capture across all EMR systems EPIC, Cerner, Soarian, Paragon, Allscripts, Vitalware, Knowledge Source etc.

AREAS OF EXPERTISE

•Revenue Cycle Management

•Coding and Billing Compliance

•CPT and HCPCS Coding

•Epic, Cerner, Soarian, Paragon

•Claims Auditing and Denials

•Charge Capture Processes

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Reimbursement Analysis

Regulatory Compliance (HIPAA, CMS, etc.)

Data Analysis and Reporting

Process Improvement

Strong Attention to Detail

Charge Reconciliation

EDUCATION

Bachelors in Health Science - University of Florida - Gainesville, FL – May 2006

PROFESSIONAL EXPERIENCE

Sr. Epic Charge Support Specialist- Feb 2025 – July 2025

Impact Advisor (Memorial Sloan Hospital)– Remote(contract Epic Go Live)

●Assist with leading projects to ensure successful deployment and integration of Epic’s healthcare applications. Coordinating with staff such as IT professionals, clinicians, and administrative staff.

●400+ Workques daily- specializing in a multitude of different service lines including Infusion administration charges, Infusion Hierarchy, E&M levels, Room and Board, DNB check, CCI edits for all inpatient and outpatient accounts. Clearing 400 accounts a day through DNB checks, Revenue Guardian checks or directly on the claim edit for Memorial Sloan Hospital.

●Charge stabilization review, monitor and root cause analysis. Charge reconciliation, charge capture etc

●Expert on EPIC onboarding and functionality, configurations, and workflow Epic Go-Live finding all trends and missed revenue opportunities.

Sr. Revenue Integrity Analyst/CDM Analyst II – Jan 2024- Feb 2025

R1 RCM– Remote, NC

●Charge Master resource to research & facilitate charge code additions and revisions. Maintained

● Maintained excel spreadsheet updating constantly and adding CPT code builds, Order IDs etc for all service lines; such as, supplies, procedures, lab, wound care, pharmacy etc.

●Researches and resolves CPT/HCPCS errors, Revenue code errors, NCCI and CCI edits and claims utilizing Vitalware and Knowledge Source.

●Supports clinical areas and departments in charge capture, coding accuracy, resolution of regulatory and payer specific edits and revenue management in order to ensure organizational wide uniformity of charges and coding for similar services and procedures.

●Identifies/investigates issues with medical necessity, coding, and billing that reduce reimbursement; recommends action steps and works collaboratively with departments to improve processes when operational weaknesses and/or compliance issues are found

●Collaborates with the revenue cycle team to identify opportunities to address and resolve billing and charging issues and/or trends to improve net revenue and reduction in denials.

●EMR systems: Paragon, Cerner and Soarian

Revenue Integrity Reporting Analyst II – July 2022-Jan 2023

Baptist Health – Remote (contract Epic Go-Live)

•Provide support for assigned service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity.

•Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payor requirements.

•Assesses the accuracy and build of all charging workflows in EPIC, including documentation, dictionaries, preference lists and other interface or third-party charging systems.

•EPIC charge capture and reconciliation reports for HB and PB.

•Provide education and auditing of reporting tool usage with departmental staff.

•Cerner and Soarian system and on-boarded EPIC.

Charge Master (CDM) Analyst II – Mar 2021-July 2022 (Promotion)

Orlando Health – Orlando, FL

•Maintains the integrity of the Charge Master by ensuring adds, changes, reactivates and inactivates are completed within 48 hours of receipt of job request

•Communicates all changes, adds, reactivates and inactivates to IS so that they can ensure the integrity of the clinical information systems charges within the EPIC system.

Liaison’s report to changes that need to be researched and made to the CDM and distribute new cost for Supplies etc. to rest of the team. Cost and budget for entire hospital revenue cycle to ensure integrity of Charge Master.

•Coordinate and maintain all activities around the Charge Description Master within hospitals (ED, L&D, Outpatient, Inpatient etc.) compliance with regulatory requirements while supporting appropriate reimbursement

Charge Management Analyst I – Feb 2017 – Mar 2021

Orlando Health – Orlando, FL

•Works independently to coordinate information and workflow of charge management hospital/professional practice area and works with charge management team, to assure completion of all charge capture within Corporate and departmental goals.

•Performs and maintains reconciliation 100% of the time for charging accuracy HB/PB.

•Continuous training and knowledge of EPIC system, Affinity, GE Centricity, etc.

•Assists support staff, coding, patient financial services, and nursing in appropriate documentation to support charging hospital/professional practice.

•Retrieves and prepares information for analysis from data systems for quality, cost and utilization reports.

•Audits and analyzes all medical record charts for appropriate documentation and charge capture HB/PB.

CERTIFICATIONS

CRCR – Certified Revenue Cycle Representative – HFMA

EPIC HB Certification- Epic UserWeb

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