Revenue & CDM Optimization Liaison

About the Role

Ensures the integrity of the Charge Description Master (CDM) and the charge capture process by providing sound advice and leadership related to individual procedures charged, CPT codes, billing requirements, and compliance issues. Coordinates and implements changes in the CDM across all information systems and facilitates CDM requests with the System Office CDM and Compliance team. Ensures CDM codes comply with Medicare and local payer guidelines. Works with clinical departments and providers throughout the organization to proactively implement changes in the charging process to enhance revenue collection while complying with local, state, federal, and third-party billing requirements.

Requirements

• Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field; or an equivalent combination of education and experience.
• Five years of experience in billing, charge documentation, charge audit, or charge capture activities, or other functions related to revenue cycle activities.
• Strong knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes, and modifiers), charging processes and audits, and clinical billing.
• Working knowledge of Professional Fee Schedule(s) from CMS, local Medicaid, and other commercial payers.
• Knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing.
• Excellent interpersonal, verbal, and written communication and organizational skills.
• Accuracy, strong analytical skills, attentiveness to detail, and time management skills.
• Certified Professional Coder (CPC), CCS, or other recognized coding certification strongly preferred.

Responsibilities

• Performs activities related to charge monitoring and follow-up, set-up and maintenance of the Charge Description Master (CDM), and supports coverage of other departmental functions.
• Partners with Physicians, Medical Records/Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance, and Managed Care department staff.
• Regularly audits the Charge Master for each department, including review of appropriate coding, departmental and pricing concerns, and other relevant issues.
• Conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal guidelines relating to charge capture and billing of services.
• Prepares and reports audit findings and makes recommendations to management.
• Approves and assists in implementing charge codes and charge practices, and provides input and recommendations related to charges for new services and all service lines.
• Analyzes financial and other documentation as required.
• Provides guidance, communication, and education on correct charge capture, billing, and coding processes, and local, state, and federal guidelines.
• Prepares special reports and analysis as directed.
• Leads and participates in committees and meetings.
• Acts as a liaison to Payer Strategies and System Office CDM and Compliance to fully understand local contracts and ensure CDM alignment.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.