CDM Specialist
CDM Specialist
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1 Vacancy
Job Description
Are you an internal caregiver student or contingent worker/agency worker at UMass Memorial Health CLICK HERE to apply through your Workday account.
Exemption Status:
ExemptSchedule Details:
Monday through FridayScheduled Hours:
8am 4:30pmShift:
1 Day Shift 8 Hours (United States of America)Hours:
40Cost Center:
CDMThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Everyone Is a Caregiver
At UMass Memorial Health everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care academic excellence and leadingedge 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 16000 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.
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.I. Major Responsibilities:
1. 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.
2. 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.
3. Promotes system wide compliance with federal state and local regulations with regard to charge codes and related information in the CDM.
4. Promotes a standardized systemwide CDM.
5. Reviews and resolves all assigned charge edits within prescribed timeframe.
6. Provides support and guidance to Clinical Charge Capture Specialist staff to resolve outstanding edits.
7. Monitors all assigned edits for resolution.
8. Monitors daily dashboards and reports as applicable and alerts supervisor of clinical departments of delinquencies as appropriate.
9. Provides regulatory coding and billing support to Clinical Charge Capture Specialists to address CDM coding charge capture and billing questions.
10. Utilizes subject matter knowledge to support proper interpretation and analysis of performance report(s).
11. 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.
12. Provides subject matter knowledge related to the CDM for clinical departments revenue cycle team finance compliance and administrative staff as required.
13. Collaborates with Hospital RI audit / education team to develop training program and materials in accordance with clinical service line structure as required.
14. Participates in education sessions by providing support resulting in optimal feedback outcomes to the clinicians as required.
15. Researches governmental and commercial payer coding and billing guidelines and regulations to ensure timely and accurate compliance of charge submission.
16. 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.
17. Collaborates with the Hospital Billing RI audit team to support the charge audit program as required.
18. Provides audit feedback to key clinical and revenue cycle stakeholders for continuous improvement as appropriate.
19. Monitors downtime forms for each assigned cost center.
Standard Staffing Level Responsibilities:
1. Complies with established departmental policies procedures and objectives.
2. Attends variety of meetings conferences seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. 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.
6. Maintains regular reliable and predictable attendance.
7. Performs other similar and related duties as required or directed.
All responsibilities are essential job functions.
II. Position Qualifications:
License/Certification/Education:
Required:
1. Bachelors degree in business administration accounting management healthcare administration nursing or other related.
Experience/Skills:
Required:
1. 35 years of work experience related to billing and coding.
2. Minimum of two 2 years of work experience required.
3. Knowledge of industry standard practices including ICD CPT / HCPCS codes and third party reimbursement policies.
4. Knowledge of coding and billing requirements based on third party publications and policies.
5. Strong interpersonal and communication skills required.
6. Ability to speak and present in front of groups required.
7. Detail oriented strong analytical skills with the ability to multi task and prioritize required.
8. A working knowledge of Microsoft Office applications ability to develop reports and create presentations.
Preferred:
1. Coding Certification (e.g. Certified Outpatient or Professional Coder American Academy of Professional Coders).
Unless certification licensure or registration is required an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.
Departmentspecific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.
III. Physical Demands and Environmental Conditions:
Work is considered sedentary. Position requires work indoors in a normal office environment.
All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or protected veteran status.
Were striving to make respect a part of everything we do at UMass Memorial Health for our patients our community and each other. Our six Standards of Respect are: Acknowledge Listen Communicate Be Responsive Be a Team Player and Be Kind. If you share these Standards of Respect we hope you will join our team and help us make respect our standard for everyone every day.
As an equal opportunity and affirmative action employer UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation national origin age disability gender identity and expression protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
