Director of Charge Description Master (CDM) & Clinical Auditing - Patient Accounting & Billing Unit

County of Riverside•Riverside, CA

4d•Onsite

About The Position

The County of Riverside's Patient Accounting and Billing Unit at Riverside University Health System (RUHS) Mission Grove location is seeking a Director of Charge Description & Clinical Auditing to join our team in Riverside. The Director of Charge Description & Clinical Auditing will be responsible for managing and optimizing the standard Charge Description Master (CDM) to ensure it is accurate and compliant with coding rules and billing regulations. This position will lead the department’s efforts in reviewing and researching charge-related data to maintain compliance and accuracy within the system's CDM. The Director will ensure that CDM maintenance requests are processed and completed efficiently, accurately, and in a timely manner. Additionally, the Director will collaborate with RUHS stakeholders to identify charge-related opportunities, evaluate current procedures, and assess internal controls to ensure charge master code compliance, charge accuracy, and improved charge capture. The role also includes maintaining oversight of the department’s documentation of policies and procedures, ensuring compliant billing practices, and educating department staff and other stakeholders on CDM maintenance processes and compliance.

Requirements

Graduation from an accredited college or university with a Bachelor's degree with coursework in business, public, healthcare, or hospital administration, or other field closely related to patient business services.
Three years of supervisory experience, which included responsibility for revenue cycle activities in a hospital or healthcare organization.
Knowledge of the principles of effective personnel management and supervision.
Knowledge of principles and practices involved in patient access or revenue cycle activities, including knowledge of applicable health information systems.
Knowledge of laws, rules, regulations, and policies affecting revenue cycle, charge master or patient access functions.
Ability to direct, coordinate, audit and evaluate the work of subordinate staff.
Ability to comprehend, interpret and apply various laws, rules and regulations related to patient access, charge master or revenue cycle operations.
Ability to develop and implement work procedures and systems to meet required standards.
Ability to establish and maintain effective working relationships with medical staff, fiscal intermediary representatives and others.
Ability to prepare clear and concise oral and written reports.

Nice To Haves

A Master's degree in Healthcare Administration, Business, or a related field
At least one (1) year of hands-on experience with Charge Description Master (CDM) management, including auditing, adding, deleting, updating, cash pricing, and OSHPD reporting.
Proven experience in clinical audits, including auditing billing charges and handling clinical payer appeals in a hospital environment.
Clinical experience as an LVN or RN is preferred
Professional-level experience with EPIC
Advanced proficiency with Microsoft Excel, including data analysis and report generation.
Bilingual skills in English and Spanish preferred.

Responsibilities

Responsible for oversight and management of CDM team.
Responsible for developing and maintaining the Charge Master standard.
Ensures that the RUHS system standard Charge Master meets federal, state regulatory requirements and guidelines and adheres to RUHS policies.
Works with departments to ensure that the Charge Master accurately reflects the services provided by the clinical departments.
Responsible for periodic reviews of all hospital charges to ensure that all charges are in compliance with RUHS system standard Charge Master.
Responsible for routinely communicating the status of CDM integrity and accuracy to key stakeholders; notifies stakeholders as appropriate when issues arise.
Provides reports and other documents as required to measure compliance to the standardized CDM.
Develop Policies and Procedures for maintaining the RUHS standard CDM incorporating the RUHS CDM Guiding Principles and Charge Policies.
Evaluates the efficiency or adequacy of Charge Master related processes and leads the development of new procedures as appropriate.
Builds and maintains effective working relationships with other departments (Epic IS, HIM/Coding, Compliance, Patient Access, Clinical depts. etc.)
Responsible for implementing routine, standardized reporting to provide stakeholders with commonly requested CDM extracts, Revenue and Usage, etc.
Serves as Charge master expert for executives and Revenue Cycle pillar leaders; and provides support to CDM team, Revenue Cycle and hospital stakeholders.
Consults with internal and external customers on the development and implementation of projects and process improvement.
Maintains communication with all stakeholders to ensure efficient operations and successful implementations; including management of customer satisfaction and expectations.