Reporting directly to the Executive Director of Revenue Cycle, the role is responsible for directing the development, coordination, implementation, and oversight of the charge defense master and revenue integrity functions.
Education:Bachelor's degree in business administration, Finance or Healthcare Administration.
Master's degree preferred (including RN, NP, PA). Clinical background as RN, NP, or PA preferred.
Experience:- Minimum of four (4) years of clinical experience or three to five (3-5) years of experience in CDM related revenue cycle processes required.
- Hospital billing and finance background strongly preferred.
- Knowledge of Medicare, Medicaid and other 3rd party billing rules/coverage.
- Professional-level experience with EPIC.
- Excellent written and communication skills.
- Proven analytical, motivation, and critical thinking skills. 3 to 5 years of experience with progressive CDM leadership experience
Certifications and Licensures:- CPC-H, CPC, or RHIT certification preferred.
- EPIC certification in CDM Management and EPIC Hospital Resolute Billing preferred OR
- EPIC certified, must obtain within 12 months.
- Epic PB Router certification OR
- Other EPIC certifications preferred
- RN, PA, NP License preferred.
Skills:- Epic CDM Management: Maintain, update, review, and validate Charge Description Master records, including charge codes, descriptions, pricing, CPT/HCPCS alignment, revenue codes, and effective dates.
- Epic Hospital Resolute Billing: Knowledge of hospital billing workflows and charge processes.
- Epic PB Router: Understand professional billing charge routing, charge review workflows, and how charges move from clinical documentation to billing.
- Epic Revenue Cycle Applications: Research charge capture issues, monitor billing and reimbursement workflows, validate system changes, and support revenue cycle improvement initiatives.
- Medicare, Medicaid, and Third-Party Payer Guidelines: Apply payer rules, coverage requirements, billing guidelines, and reimbursement policies to support compliant charging and billing practices.
- Microsoft Excel: Experience with Microsoft Excel would be helpful for the role. Useful skills may include pivot tables, filters, sorting, formulas, lookups, conditional formatting, data validation, reconciliation tools, variance analysis, trend analysis, and reporting summaries to review charge, billing, reimbursement, denial, and revenue integrity data.
- Reporting/Dashboard Tools: Experience with reporting and analytics platforms would be a nice-to-have for the position. Examples include Epic Reporting Workbench, SlicerDicer, Cogito, Tableau, Microsoft Power BI, SQL-based reporting tools, Crystal Reports, SSRS (SQL Server Reporting Services), and healthcare revenue cycle dashboards used to monitor revenue cycle KPIs, charge capture trends, reconciliation status, lost revenue opportunities, billing variances, denial patterns, and revenue integrity workplan progress.
Physical Requirements:- Work is primarily performed in an office or hospital administrative setting, with frequent use of a computer, keyboard, mouse, phone, and other standard office equipment.
- Requires prolonged periods of sitting and viewing a computer screen while reviewing charge data, billing information, reports, spreadsheets, system workflows, and documentation.
- Work may be performed in areas with limited natural light, standard office lighting, and routine exposure to computer screen glare or visual fatigue.
- Requires occasional standing, walking, bending, reaching, and lifting or carrying light office materials, files, binders, or equipment up to approximately 10 pounds.
- Work may require occasional movement throughout hospital or clinic areas for meetings, workflow review, training, or collaboration with clinical and operational departments.
- May have limited exposure to patient care areas or hospital environments where standard precautions are required and where there may be potential exposure to infectious agents, germs, or other healthcare-related environmental conditions.
- Requires adherence to organizational safety, infection prevention, confidentiality, and standard precaution policies while working in hospital, clinic, or patient care-adjacent areas.
Principal Duties and Responsibilities:A. Revenue Integrity Operations- Directs and oversees revenue integrity functions to support accurate, compliant, and timely charge capture, billing, reimbursement, and revenue cycle performance.
- Monitors charge capture, pre-bill edits, charge reconciliation, and revenue integrity reviews to identify billing errors, reduce denials, prevent rework, and support clean claim submission.
- Monitors revenue departments' adherence to charge reconciliation processes, work plan activities, and key performance indicators related to charge capture, billing accuracy, and revenue integrity.
- Identifies, investigates, and resolves revenue integrity risks, concerns, variances, and potential compliance issues; escalates matters as appropriate.
- Develops tools, reports, and tracking mechanisms to identify potential lost revenue, charge capture gaps, reimbursement opportunities, and process improvement needs.
- Monitors regulatory, legislative, payer, coding, billing, and reimbursement changes impacting revenue integrity practices.
- Provides periodic and ad hoc reports to the Executive Director of Revenue Cycle regarding revenue integrity program status, corrective actions, risks, findings, and recommended changes.
- Develops and delivers revenue integrity education and training for staff and departments in partnership with Revenue Cycle leadership.
- Leads revenue integrity meetings, workgroups, staff meetings, and committee discussions to track progress, address issues, and support coordinated revenue cycle improvement.
- Partners with Revenue Cycle, Patient Accounting, Finance, IT, Epic, Coding, Managed Care, clinical departments, and operational leaders to improve billing efficiency, collections, payer enrollment, credentialing, charge accuracy, and reimbursement performance.
- Supervises, mentors, develops, and evaluates analyst staff supporting patient accounting, revenue integrity, and related operational work.
B. Charge Description Master / CDM Operations- Maintains and optimizes the Charge Description Master to ensure billable services, supplies, devices, drugs, procedures, and other chargeable items are accurately reflected and aligned with CPT, HCPCS, revenue code, payer, and regulatory requirements.
- Leads annual, quarterly, and ongoing CDM maintenance activities, including review of CPT, HCPCS, and revenue code changes to ensure accuracy, compliance, and reimbursement optimization.
- Reviews, evaluates, and approves new or revised department charges to ensure appropriate coding, billing compliance, and prevention of overcharging, undercharging, or missed revenue opportunities.
- Ensures CDM updates are coordinated with clinical systems, Epic applications, billing workflows, and affected operational departments to support accurate charge generation and downstream revenue cycle processes.
Pay Range$89,456.67 - $161,022.00
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
