CDM Analyst - Revenue Integrity - Remote

About this role

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REMOTE REQUIREMENT Must be a resident of Texas, Louisiana, Mississippi, Alabama, Florida or Georgia

The CDM (Charge Description Master) Analyst is responsible for supporting the maintenance and optimization of the Charge Description Master (CDM) by analyzing charge codes, conducting data audits, and ensuring regulatory compliance. The CDM Analyst plays a critical role in ensuring the accuracy and efficiency of charge capture processes across clinical departments.

Your Everyday • Review and analyze CDM data to ensure that all charge codes are accurate, current, and compliant with industry standards and payer regulations. • Conduct regular audits of charge codes, procedure codes, and pricing to identify discrepancies or areas for improvement. • Assist in updating the CDM by adding, modifying, or deleting charge codes as needed, in line with regulatory changes or departmental requests. • Ensure that all changes to the CDM are appropriately documented and communicated to relevant departments. • Analyze charge capture processes to ensure that services provided are accurately billed and correctly reflected in the CDM. • Identify any missing or incorrect charges, working with clinical and billing teams to resolve issues. • Ensure that all updates and modifications to the CDM adhere to regulatory guidelines, such as those from CMS, Medicare, Medicaid, and other payers. • Monitor industry changes and payer updates to stay informed of new coding and billing requirements. • Work with clinical, billing, and coding departments to address charge capture issues and ensure proper usage of CDM codes. • Act as a resource for staff on CDM-related inquiries and charge coding concerns. • Participate in audits of the CDM, assisting with the identification of any discrepancies in charge capture and compliance. • Provide documentation and analysis during external audits, ensuring timely and accurate responses. • Generate reports on CDM activity, including charge capture trends, audit results, and compliance metrics. • Ensure the integrity and accuracy of CDM-related data by performing regular data quality checks. • Identify opportunities to improve charge capture processes and optimize revenue by analyzing CDM usage and patterns. • Provide recommendations for enhancing the efficiency and accuracy of CDM-related operations.

The Must-Haves

Minimum:

• Review and analyze CDM data to ensure that all charge codes are accurate, current, and compliant with industry standards and payer regulations. • Conduct regular audits of charge codes, procedure codes, and pricing to identify discrepancies or areas for improvement. • Assist in updating the CDM by adding, modifying, or deleting charge codes as needed, in line with regulatory changes or departmental requests. • Ensure that all changes to the CDM are appropriately documented and communicated to relevant departments. • Analyze charge capture processes to ensure that services provided are accurately billed and correctly reflected in the CDM. • Identify any missing or incorrect charges, working with clinical and billing teams to resolve issues. • Ensure that all updates and modifications to the CDM adhere to regulatory guidelines, such as those from CMS, Medicare, Medicaid, and other payers. • Monitor industry changes and payer updates to stay informed of new coding and billing requirements. • Work with clinical, billing, and coding departments to address charge capture issues and ensure proper usage of CDM codes. • Act as a resource for staff on CDM-related inquiries and charge coding concerns. • Participate in audits of the CDM, assisting with the identification of any discrepancies in charge capture and compliance. • Provide documentation and analysis during external audits, ensuring timely and accurate responses. • Generate reports on CDM activity, including charge capture trends, audit results, and compliance metrics. • Ensure the integrity and accuracy of CDM-related data by performing regular data quality checks. • Identify opportunities to improve charge capture processes and optimize revenue by analyzing CDM usage and patterns. • Provide recommendations for enhancing the efficiency and accuracy of CDM-related operations.

EXPERIENCE QUALIFICATIONS: • 3+ years of experience in healthcare auditing, revenue integrity, revenue cycle management, healthcare finance, or a related field • Minimum of 2 years’ experience as an analyst in a healthcare environment with emphasis on chargemaster, revenue capture, charge auditing, reporting and reimbursement. • Must have 3 years of experience in a hospital or professional based CPT-4, HCPCS Level II coding and outpatient ICD-10-CM coding experience for multiple hospital departments. • Strong knowledge of Chargemaster (CDM) management, including charge capture processes, coding (CPT, HCPCS, ICD-10), and compliance with CMS and third-party payer requirements.   • 2+ years of Epic experience, particularly in managing work queues and charge capture functions 

EDUCATION QUALIFICATIONS: • Minimum: An associate’s degree in healthcare administration, health information management, or a related field is required. • Preferred: Bachelor's degree in healthcare

LICENSES AND CERTIFICATIONS: • Preferred: AAPC or AHIMA credential or Epic Certified

SKILLS AND ABILITIES: • Demonstrate knowledge of OPPS reimbursement methodologies, as well as Medicare reimbursement and billing guidelines, familiar with CMS transmittals and manuals, and with the cms.gov website to obtain quarterly HCPCS, OCE, and MUE updates  • Demonstrate knowledge of NUBC revenue codes, mapping structures, UB-04 claim and payment remittance advice statements • Demonstrate knowledge of the medical necessity of services through the CMS Local and National coverage Determinations • Demonstrated ability to establish and maintain effective working relationships at all levels. • Demonstrated ability to work independently. • Working knowledge of medi

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