CDM Spec

UMass Memorial Health•Worcester, MA

2d•$56,243 - $101,254•Onsite

About The Position

Serves as a Charge Description Master (CDM) and regulatory gatekeeper to ensure compliance with coding and billing guidelines. Reviews all assigned edits within prescribed timeframe and routes to appropriate owner for resolution. Provides regulatory coding and billing support to Clinical Charge Capture Specialists to address CDM, coding, charge capture and billing questions. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Requirements

Bachelor’s degree in business administration, accounting, management, healthcare administration, nursing or other related.
3-5 years of work experience related to billing and coding.
Minimum of two (2) years of work experience required.
Knowledge of industry standard practices, including ICD, CPT / HCPCS codes and third party reimbursement policies.
Knowledge of coding and billing requirements based on third party publications and policies.
Strong interpersonal and communication skills required.
Ability to speak and present in front of groups required.
Detail oriented, strong analytical skills with the ability to multi task and prioritize required.
A working knowledge of Microsoft Office applications, ability to develop reports and create presentations.

Nice To Haves

Coding Certification (e.g. Certified Outpatient or Professional Coder, American Academy of Professional Coders).

Responsibilities

Serves as a gatekeeper to ensure that routine and annual CDM updates are in compliance with all governmental and commercial payers regulatory coding and billing guidelines and reflect clinical practice.
Collaborates with clinical / ancillary departments and Information Technology (IT) department to facilitate appropriate use of CDM, maintain CDM requests and synchronize preference lists and orders in IT applications, as appropriate.
Promotes system wide compliance with federal, state and local regulations with regard to charge codes and related information in the CDM.
Promotes a standardized, system-wide CDM.
Reviews and resolves all assigned charge edits within prescribed timeframe.
Provides support and guidance to Clinical Charge Capture Specialist staff to resolve outstanding edits.
Monitors all assigned edits for resolution.
Monitors daily dashboards and reports, as applicable, and alerts supervisor of clinical departments of delinquencies as appropriate.
Provides regulatory coding and billing support to Clinical Charge Capture Specialists to address CDM, coding, charge capture and billing questions.
Utilizes subject matter knowledge to support proper interpretation and analysis of performance report(s).
Ensures the CDM structure supports effective capture of all chargeable services based on a thorough knowledge of the charge capture methods and department processes / workflows.
Provides subject matter knowledge related to the CDM for clinical departments, revenue cycle team, finance, compliance and administrative staff, as required.
Collaborates with the Hospital RI audit / education team to develop training program and materials in accordance with clinical service line structure, as required.
Participates in education sessions by providing support resulting in optimal feedback outcomes to the clinicians, as required.
Researches governmental and commercial payer coding and billing guidelines and regulations to ensure timely and accurate compliance of charge submission.
Participates in annual review process for assigned area by providing updates regarding CPT, CMS regulatory updates, society publications (e.g., ASA) for clinical, administrative, compliance, revenue cycle and finance.
Collaborates with the Hospital Billing RI audit team to support the charge audit program, as required.
Provides audit feedback to key clinical and revenue cycle stakeholders for continuous improvement, as appropriate.
Monitors downtime forms for each assigned cost center.
Complies with established departmental policies, procedures and objectives.
Attends variety of meetings, conferences, seminars as required or directed.
Demonstrates use of Quality Improvement in daily operations.
Complies with all health and safety regulations and requirements.
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
Maintains, regular, reliable, and predictable attendance.
Performs other similar and related duties as required or directed.