Description

Nemours is seeking a Sr. CDM Specialist in Orlando, FL

This position is responsible for: assistance in maintenance of Charge Description Master (CDM) within Nemours hospital revenue producing departments. Works with the CDM/HB Manager to ensure an accurate CDM and Coding process resulting in clean and compliant claims. Acts as liaison and problem solver for CDM issues with Administration, insurance companies, charge capture departments, Health Information Management, Utilization Management, Recovery Auditors, Managed Care, Corporate Compliances, and Central billing Office (CBO).

Responsibilities:

1. Responsible for the coordination of ongoing CDM consistency within revenue producing departments. Includes maintaining accurate descriptions, coding, in-activations, and revenue code assignments.

2. Demonstrate and incorporate a working knowledge of the hospital's billing and coding software applications as related to coding and billing of encounters.

3. Maintains an extensive working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist in cash collection while accurately complying with billing/coding guidelines.

4. Reviews denials from CBO relating to payor rejections and incomplete reimbursement resulting from CDM issues, coding, and billing issues.

5. Assists Recovery Audit staff with all CDM related hospital charge capture inquiries.

6. Conducts research related to CDM and hospital billing issues using various types of information media: internet, payor intranet, payor newsletters and/or manuals.

7. Works closely with EPIC IS application support relating to all CDM hospital billing functions: ADT (Admission Discharge Transfer), Ambulatory, Charge Router, Willow, and Radiant.

8. Ability to read and comprehend the medical record to identify all diagnoses, procedures and services for the patient encounter for outpatient and emergency room services.

9. Assists Coding Manager with coding duties.

Requirements:

• 5 years hospital billing and coding; 3-5 years of charge master experience

• Epic Certification within 1 year of hire

• Bachelor's degree required

• Required COC or CPC

• Preferred HFMA CRCR, AAHAM, CRCS-I CHFP CRCS-P

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