CDM Specialist, Hospital Claims.

Exemption Status:

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

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 16,000 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.

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, system-wide 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.

II. Position Qualifications:

License/Certification/Education:
Required:
1. Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related.

Experience/Skills:
Required:
1. 3-5 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.

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.

We're 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 talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.