Reimbursement and CDM Manager, Day Shift, Reimbursement

About the role

Adventist HealthCare seeks to hire an experienced Reimbursement and CDM Manager for our Reimbursement Department.

Responsibilities

• Monitor GBR performance, unit rate compliance, and reimbursement trends for all AHC entities subject to HSCRC and CMMI/AHEAD requirements; recommend and implement pricing adjustments consistent with regulatory requirements and AHC strategy.
• Prepare comprehensive monthly reimbursement and revenue packets, including earned revenue recognition, rate control reconciliation, volume analysis, budget variance analysis, performance dashboards, and the monthly journal entry for Accounting.
• Provide enterprise oversight of the Charge Description Master (CDM), including review, approval, implementation, and maintenance of charge codes, pricing, revenue codes, CPT/HCPCS codes, modifiers, units, descriptions, and other billing components.
• Partner with Revenue Integrity, Revenue Cycle, Clinical Departments, Compliance, Reimbursement, and Information Technology to support accurate charge capture, compliant charging practices, and alignment with reimbursement strategy.
• Participate in multidisciplinary CDM governance, routine CDM and charge-capture audits, annual coding updates, and corrective action activities.
• Monitor regulatory changes affecting charging and reimbursement, and participate in Epic implementation, conversion, testing, upgrades, and optimization related to charging workflows, pricing, and CDM functionality.
• Schedule and download monthly volume and revenue reports for HSCRC reporting; collaborate with Data Engineering and Information Technology to improve report accuracy, controls, and automation.
• Prepare quarterly HSCRC reporting, including case mix reconciliation, denials, Uncompensated Care (UCC), and other required regulatory submissions.
• Perform detailed reviews and budget reconciliations of HSCRC rate orders; identify discrepancies and collaborate with internal and external stakeholders to validate rate orders and resolve issues.
• Prepare workpapers supporting the HSCRC Annual Filing, Medicare Cost Report, HSCRC Special Audit, and other reimbursement filings for all entities; coordinate with external auditors and regulatory agencies as needed for issue resolution.
• Prepare in collaboration with Managed Care and other stakeholders, the annual CMS Hospital Price Transparency files for all AHC entities and support ongoing compliance with applicable disclosure requirements.

Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or a related field required.
• Five (5) or more years of progressively responsible experience in healthcare reimbursement, hospital finance, revenue cycle, revenue integrity, or Charge Description Master management.
• Maryland HSCRC reimbursement and regulatory reporting experience strongly preferred.
• Prior leadership, project leadership, or experience coordinating multidisciplinary teams preferred; direct supervision of Revenue Integrity is not required.
• Knowledge and experience with HSCRC reimbursement methodologies, Global Budget Revenue, Maryland rate setting, and regulatory reporting.
• Knowledge of Medicare reimbursement, hospital charging practices, CDM maintenance, pricing, CPT/HCPCS codes, revenue codes, and charge governance.
• Demonstrated ability to partner with Revenue Integrity and operational teams on charge-capture accuracy, compliance, and process improvement.
• Epic Resolute Hospital Billing and Epic CDM experience preferred.
• Experience supporting an Epic implementation, conversion, testing, upgrade, or optimization project.
• Experience with CMS Hospital Price Transparency, Medicare Cost Reports, Power BI, and the CMMI AHEAD Model.

Work Schedule

Full-time, 40 hours/week, Day Shift-Hybrid Schedule.

Pay Range

$105,664.42 - $158,496.00