CDM Analyst – Revenue Integrity

This is a fully remote position, open to applicants in Alabama, +4 more states.

📋 Description

• Review and evaluate Charge Description Master (CDM) data for precision, relevance, and compliance.

• Perform audits on charge codes, procedure codes, pricing, charge capture, and compliance.

• Add, modify, or remove charge codes in response to regulatory updates or departmental requests.

• Document and relay CDM modifications to pertinent departments.

• Analyze billing and charge capture workflows and address any missing or incorrect charges in coordination with clinical and billing teams.

• Keep abreast of CMS, Medicare, Medicaid, and payer coding and billing standards.

• Collaborate with clinical, billing, and coding departments regarding CDM-related matters.

• Serve as a resource for staff on CDM questions and charge coding issues.

• Assist with internal and external audits by providing documentation, analysis, and prompt responses.

• Produce reports detailing CDM activity, trends, audit findings, and compliance metrics.

• Conduct data quality assessments and propose process enhancements to optimize revenue and CDM functions.

⛳️ Requirements

• Must reside in Texas, Louisiana, Mississippi, Alabama, Florida, or Georgia.

• 3+ years of experience in healthcare auditing, revenue integrity, revenue cycle management, healthcare finance, or a similar field.

• At least 2 years of experience as an analyst in a healthcare setting focused on chargemaster, revenue capture, charge auditing, reporting, and reimbursement.

• 3 years of experience with hospital or professional CPT-4, HCPCS Level II, and outpatient ICD-10-CM coding across various hospital departments.

• Strong understanding of Chargemaster/CDM management, charge capture, CPT, HCPCS, ICD-10, CMS, and third-party payer requirements.

• 2+ years of experience with Epic, particularly related to work queues and charge capture functions.

• An associate’s degree in healthcare administration, health information management, or a related discipline is required.

• Familiarity with OPPS, Medicare reimbursement and billing guidelines, CMS transmittals and manuals, HCPCS, OCE, and MUE updates.

• Understanding of NUBC revenue codes, mapping structures, UB-04 claims, and payment remittance advice statements.

• Knowledge of CMS Local and National Coverage Determinations and medical necessity.

• Working knowledge of medical terminology, CPT, HCPCS, ICD-10, and Revenue Codes.

• Awareness of Medicare, Medicaid, Medicare OPPS reimbursement, third-party billing regulations, and coverage determinations.

• Advanced computer skills, including proficiency in spreadsheets, word processing, databases, Microsoft applications, and the ability to swiftly learn new systems.

• Proficiency in Excel and Office 365, including Word, Excel, PowerPoint, Outlook, Teams, and SharePoint.

• Proven skills in process improvement, analysis, problem-solving, organization, and multitasking.

• Ability to operate independently with minimal supervision as well as collaboratively within a team.

• Excellent verbal and written communication skills, including the ability to produce formal reports, analyses, and presentations.

• Extensive experience with CPT, ICD-10, and UB-04 billing.

• Preferred: Bachelor’s degree in healthcare.

• Preferred: AAPC or AHIMA certification or Epic Certification.

🏝️ Benefits

• Equal opportunity employment

• Work shift: Days (United States of America)