Reimbursement and CDM Manager, Day Shift, Reimbursement

Adventist HealthCare • Gaithersburg, MD

80d • Hybrid

About The Position

Adventist HealthCare seeks to hire an experienced Reimbursement and CDM Manager for its Reimbursement Department who will embrace its mission to extend God’s care through the ministry of physical, mental, and spiritual healing. This role involves monitoring reimbursement performance, ensuring unit rate compliance, and analyzing reimbursement trends for all AHC entities. The manager will also provide enterprise oversight of the Charge Description Master (CDM), partnering with various departments to ensure accurate charge capture and compliant charging practices. Additionally, the role includes preparing regulatory reports, managing HSCRC rate orders, and supporting price transparency requirements.

Requirements

• 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.
• 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.

Nice To Haves

• 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.
• 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.

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.

Benefits

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level