In charge of maintenance, compliance, and integrity of the Hospital Billing (HB) and Professional Billing (PB) Charge Description Master (CDM), along with related charge review edits and router workqueue logic.
Analyze and configure charge capture workflows, managing technical charging requests, and the coordination of research, training, and communication with hospital administrators affected.
Collaborate with external pricing vendors to manage and execute the implementation of both facility pricing architecture and professional fee schedules, ensuring accurate CPT/HCPCS and revenue code compatibility for accurate billing detail and compliance regulations.
Stay updated of all CDM related policies and procedures as necessary.
Maintain all CDM requests across both Hospital Billing (HB) and Professional Billing (PB) structures for charge code additions, revisions, and deletions.
Continuously monitor, track, and resolve Epic charge review workqueues (WQs) and billing exceptions to minimize claim delays and decrease Days in A/R.
Coordinate with Information Systems to build, test, and implement approved charge codes within the EHR, ensuring seamless integration with Charge Router logic and clinical workflows.
Thoroughly analyze each request for accurate pricing alignment based on vendor strategy tables, establishing fee schedules, CPT/HCPCS, and revenue code compatibility.
Research current and future complex Medicare, Medicaid, and commercial payer regulations to ensure optimal revenue preservation, prevent resource leakage, and maintain absolute billing compliance.
Qualifications:
Associates degree or higer with minimum five (5) years of direct, dedicated CDM maintenance experience and a minimum of seven (7) years of general healthcare revenue cycle experience (such as Revenue Integrity, Medical Coding, or Billing), or High School Diploma / GED with minimum of eight (8) years of direct, dedicated CDM maintenance experience and a minimum of ten (10) years of general healthcare revenue cycle experience (such as Revenue Integrity, Medical Coding or Billing).
Knowledge of medical terminology, medical billing and reimbursement methodologies, UB-04 revenue codes, CPT and HCPCS Level II coding systems, applicable coding modifiers.
Epic CDM experience.
Epic Hospital Billing certification.
Current AAPC or AHIMA certification.
Proven ability to organize and track project-type work.
Working knowledge of CMS/HCFA regulations, payer guidelines, and revenue cycle compliance standards.
Strong analytical, problem-solving, and critical thinking skills.
Demonstrated attention to detail and high degree of accuracy.
Proficiency in Microsoft Office applications, including Excel, Word, PowerPoint, and Access.