Senior Revenue Integrity CDM Coordinator

Job Description:

Under the general supervision of the Director of Revenue Integrity, is the technical subject matter expert responsible for supporting and maintaining the ongoing Charge Description Master (CDM) within WellSpan entities. The role assists in the planning, implementation and management of CDM process improvement initiatives and projects that support business needs. Project work is strategic and requires the facilitation of change management and process improvement techniques and methodologies related to the corporate CDM. Position determines CDM codes in compliance with Medicare, Medicaid and Commercial guidelines. This position manages work assignments, provides guidance in coordinating projects, managing deliverables and serves as a resource for ad-hoc problem solver, and troubleshooting. This position works on special revenue projects as directed by the Revenue Management leadership.

Duties and Responsibilities

1. Responsible for the coordination of ongoing CDM consistency within revenue producing departments, which includes maintaining accurate charge descriptions, CPT/HCPCS coding, modifier and revenue code assignments.
2. Maintain an extensive working knowledge of the hospital revenue cycle process to aid in the implementation of regulatory standards that assist in cash collections while accurately complying with billing guidelines.
3. Performs extensive research analyses, identifies trends and reviews denials from Patient Financial Services related to payer rejections and incomplete reimbursement resulting from CDM issues.
4. Develops corporate CDM requests for additions, deletions and other changes to ensure an accurate charge master database.
5. Develops charge master educational training materials, job aides, tip sheets and provides support and training in charge master and charge capture concepts.
6. Monitors quarterly Federal and commercial bulletins for HCPCS/CPT code changes and additions and Epic programming rule changes that affect charge functions.
7. Facilitates the implementation of annual Outpatient Prospective Payment System final rule and annual AMA coding changes for all hospital clinical services within WellSpan.
8. Works with Revenue Analytics, Finance and Clinical Management to understand budget and net revenue impact resulting from CDM charge changes.
9. Lead in revenue optimization initiatives and collaborates with revenue cycle business partners on system enhancements and upgrades.
10. Maintains a working knowledge of applicable Federal, State regulations, WellSpan Health Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
11. Coordinates CDM reviews with management, Compliance and outside consultants, as needed.

Qualifications

• Notes:
  • Other combinations of formal education, training and experience may be considered.

• Minimum Experience:
  • 5 years of coding and reimbursement experience

• Minimum Education:
  • Diploma or GED

• Minimum Field Of Expertise:
  • Inpatient/outpatient coding systems and coding compliance

• Preferred Education:
  • Bachelor’s Degree in a health services discipline

• Required Certification:
  • At least one of the following Certifications: 
  • Certified Procedural Coder (CPC), Certified Outpatient Coder (COC) or
  • Certified Coding Specialist-Physician (CCS-P)

• Skills:
  • Extensive knowledge of hospital financial operations including CDM development and revenue cycle processes including CPT/HCPCS coding principles and guidelines. Good working knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing. Exceptional analytical and problem-solving skills in order to define problems, collect data, establish data, establish facts, and draw valid conclusions. Extensive knowledge of Best Practice Standards of Coding and identification of reliable compliant reference sites and/or materials. Strong interpersonal skills. Excellent written and oral communication skills. Must be able to work independently without supervision.