Director of Enterprise Charge Description Master (CDM) Patient Financial Services-Corporate 42nd Street-Full-Time Days- Hybrid

Director of Enterprise Charge Description Master (CDM) -Patient Financial Services-Corporate 42nd Street-Full-Time -Days- Hybrid

The Director of the Enterprise Chargemaster (CDM) for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) (which includes the MSHS and the Faculty Practice Plan) is a leadership role responsible for implementing the overall strategic direction and operational oversight for the professional charge description master the Enterprise CDM optimization and provide facility strategic pricing.

This position plays a key role in ensuring the financial health and compliance of the organization and integrates the facility and professional chargemaster process for a seamless workflow and provides facility strategic pricing. This position will report to the Senior Director Finance of the MSHS.

• Responsible for management and adherence to all Federal State and Regulatory requirements and guidelines for the Professional Charge Description Master.
• Responsible for developing and maintaining the Professional Charge Description Master and integrating the Facility and Professional Charge Description Master (CDM) as appropriate.
• Collaborate with financial clinical technical and operational stakeholders to facilitate the planning execution and successful transition of data from legacy Charge Description Master to the Epic platform.
• Develops strategic pricing initiatives collaborating with key stakeholders to ensure alignment with business objectives and market conditions.
• Works with providers and clinical areas to ensure the MSHS Enterprise CDM accurately reflects the services provided.
• Develops policies and procedures for maintaining the MSHS Enterprise CDM.
• Responsible for oversight of all new charge code requests ensuring correct Enterprise Charge Description Master build mapping and communication to appropriate teams.
• Responsible for implementing routine standardized reporting to provide stakeholders with commonly requested MSHS Enterprise CDM extracts revenue and usage and other reporting.
• Serves as an Enterprise Charge Description Master resource for executives and leadership and provides support to the MSHS Enterprise CDM team revenue cycle and hospital stakeholders.
• Responsible for a detailed annual review of the Enterprise CDM to ensure compliance with all Federal and State regulations and accurately reflects charges for all services provided.
• Assesses and identifies services that are reimbursable but are not being coded; reviews assigns and validates revenue codes to insure proper billing in collaboration with other revenue cycle teams.
• Works in conjunction with stakeholders to ensure that any third-party systems have appropriate charge codes and two way extracts as appropriate.
• Communicates and reviews impact on operations of third-party requirements for charging coding or billing changes with defined stakeholders.
• Develops and or maintains reports to identify various metrics as defined by leadership or needed for departmental monitoring.
• Serve as the subject matter expert based on experience and certification for clinical departments finance and information technology.
  Collaborate with multi-disciplinary teams to manage and reduce candidate for billing (CFB).
• Engage with IT teams and vendors to implement system upgrades enhancements and automation solutions.
• Mitigate the risk of compliance violations audits and potential penalties related to charging and billing errors.
• Resourceful in creating or fine-tuning the processes necessary to complete the work along with the ability to organize people and activities.
• Challenge existing norms or courses of action to facilitate fully informed decision-making.
• Help institute balanced decision-making by identifying risks and opportunities.
• Establish and maintain strong working relationships with revenue cycle leaders key stakeholders and foster a strong working relationship with key strategic partners.
• Create feedback loops and enhancement pipelines informed by stakeholders and data.
• Ensure compliance with all HIPAA privacy and security standards.
• Conform to the established policies/ procedures/ processes/ Standards of Behavior.
• Performs other duties as assigned

• Bachelors degree in public health/administration or business or a related field or equivalent education experience and certification.

• Ten (10) plus years experience in a health system setting responsible for the Charge Description Master preferably in an academic medical center.

• 5 plus years with Epic Experience
• Demonstrated success in a large not-for-profit/academic health system facility or multi-entity revenue cycle environment.
• Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM UB RAs and 1500. Extensive knowledge of code data sets to include CPT HCPCS and ICD 10. Extensive knowledge of NCCI edits and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG OPPS HCC and managed care. Extensive working knowledge of health care compliance.
• Capacity to review analyze and interpret managed care contracts billing guidelines and state and federal regulations along with facilitating to all member entities. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians nursing staff leadership and other billing personnel.
• Excellent interpersonal skills and experience working with senior management and other leaders along with the ability to communicate concepts to others.
• Demonstrated ability to engage in positive powerful persuasion with individuals or groups with diverse opinions and/ or agendas leading to outcomes that meet identified goals.
• Excellent verbal and written communication and organizational abilities. Accuracy attentiveness to detail and time management skills are required.
• Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes.
  

Certification:

Applicable professional certification through AHIMA (RHIA RHIT CCS CCS-P) or AAPC (CPC COC) preferred

Non-Bargaining Unit 518 - PFS 633 Third Avenue - MSH Mount Sinai Hospital