Charge Description Master Specialist

Charge Description Master Specialist

The Charge Description Master Specialist performs ongoing Charge Description Master (CDM) reviews throughout the year to ensure the accuracy and completeness of the hospital chargemaster. This includes coordinating, monitoring, and approving all changes made to the CDM; tracking and reporting all CDM maintenance activities; and acting as a liaison between the Revenue Integrity Specialist and hospital revenue-generating departments. This ensures departmental charge options comply with federal and state coding and billing regulations while supporting appropriate and optimal reimbursement.

The specialist also oversees the process for new service and new supply requests and is responsible for creating and maintaining associated procedures and policies. They work with the Patient Financial Services department to resolve denial issues related to billed CPT, HCPCS, and revenue codes linked to the CDM. Additionally, they assist with special projects as requested; oversee processes and reporting related to Revenue Guardian; and perform daily maintenance of assigned work queues.

This role requires a broad understanding of, and close collaboration with, representatives across all areas of the revenue cycle, including Patient Financial Services (PFS), Health Information Management (HIM), Case Management, and Contracting and Reimbursement Services. The specialist must also demonstrate the ability to interact effectively across the organization.

Mostly Remote (Monday-Friday; 8am-5pm) for optimal work-life balance

Onsite requirements: Quarterly onsite meetings with team required at CHOP- to inspire teamwork by bringing the group together to plan boldly, connect meaningfully, and innovate for lasting impact.

Ready to grow with us? Apply today and help shape the future of Revenue Cycle at CHOP.

What You Will Do

1) CDM Maintenance

• Responsible for all Charge Description Master (CDM) updates and changes.
• Tracking of all CDM additions, deletions, and other changes.
• Ensure needed changes to the CDM are completed on a timely basis.
• Seek feedback from Compliance, as needed, related to regulations and standards set forth by regulatory bodies to help validate that charge codes and services in the CDM are compliant with routine hospital billing practices.
• Bi-annual CDM review to identify charge variances and implement charge changes when deemed necessary.
• Tracking and validation of zero-priced charges, with maintenance of the historical rationale.
• Annual CDM review to identify possible services and supplies to be considered for procedural and/or room inclusion, with associated analysis of the impact of the charge inclusion.
• Serves as the subject matter expert for the charge master tool.
• Works closely with IT/Parc Support to validate end-to-end completion of all work associated with a CDM maintenance request.
• Daily maintenance of assigned WQs with monthly reporting of any issue requiring CDM maintenance

2) Coordinate annual/periodic CDM updates

• Annual analysis of all CPT/HCPCS code changes as maintained by the AMA and Medicare.
• Identification of any code changes with direct correlation to services, procedures, and supplies currently in the CDM; identification of any code changes to be considered as possible new revenue opportunities.
• Document all annual code changes and report in a format that can be used for communication to the Revenue Integrity Specialist and revenue-generating departments as a means to initiate discussion, provide needed charge education, and facilitate the timely completion of CDM maintenance by January 1st.
• Perform needed CDM maintenance specific to the receipt of code changes identified via quarterly payor bulletins or notifications received by the Revenue Integrity Manager.

3) New service/New Supply requests

• Intake and processing of all requests received from hospital revenue-generating departments.
• Create and maintain policies and procedures related to the process for new service or new supply requests, with review of the policy every three years.
• Function as the subject matter expert regarding services and supplies determined to be chargeable or not separately chargeable.
• Work with the Reimbursement Manager in the analysis and determination of charge pricing and changes.
• Work closely with IT/Parc Support to ensure testing of new requests and the associated build is completed in a timely manner per policy, including validating with the requesting department that the item is on their charge screen (as applicable).
• Analysis of new service or new supply requests as possible recommendations for a Revenue Guardian check.

4) Responsible for analyzing code denials

• Daily maintenance of the CDM Denial Work Queue (WQ) for reported PFS claim denials.
• Conduct root cause analysis of code denials.
• Track and report denial findings and implement needed CDM changes, as applicable.
• Serve as the primary contact for all CPT, HCPCS, and revenue code denials received from non-PFS departments that have been validated as linked to codes originating from the CDM.
• Participate in PFS meetings to provide feedback on Work Queue issues and denial findings.
• Analyze Work Queue issues and CDM denials for possible recommendation of a Revenue Guardian check.

5) Responsible for coordinating periodic update meetings with key stakeholders:

• Collaborates with key stakeholders, including Reimbursement, Compliance, and PARC Support.
• Helps to reduce compliance risks by studying, reporting, and making recommendations related to ongoing and emerging coding compliance issues.
• Participates in project team meetings that involve the review of system programs and services related to the development of potential changes impacting hospital charge capture or the charge entry process.

Standards for CDM Specialist

1) Establishes department standards of excellence.

• Annually reviews, revises, and documents all key departmental processes and develops standards of excellence consistent with the hospital's mission, values, and quality vision.
• Compares and integrates industry best practices within the department.
• Annually evaluates and measures the department's achievement of defined standards of excellence.

2) Establishes integrated systems that improve services and support the hospital's mission.

• Collects and/or reviews data from customer surveys on specific departmental programs or hospital-wide systems.
• Uses institution-wide surveys to enhance department services on an ongoing basis.
• Annually participates in and/or contributes to at least one (1) CQI cross-functional and/or departmental quality improvement initiative.

3) Develops, tests, implements, and evaluates new and creative approaches to meeting departmental and institutional goals.

• Annually prepares written, measurable goals for the department.
• Participates in a work group to improve departmental or cross-functional processes.
• Uses innovative and/or non-traditional approaches to implement changes that enhance the department's or institution's ability to meet goals.

4) Integrates trends in healthcare and the profession to forecast future departmental and institutional needs for program development, space, and financial resources.

• Initiates at least one realistic tactical or strategic planning recommendation annually based on trend data and/or benchmarking.
• Makes recommendations for technical enhancements (e.g., tools, software, etc.) that support the department's vision of increased automation of work efforts related to CDM maintenance.

5) Responds promptly and positively to patients, families, associates, and others in a respectful, courteous, and confidential manner.

6) Follows hospital and department procedures and policies, including but not limited to patient safety, mandatory education, confidentiality, attendance, etc.

Education Qualifications

• Bachelor's Degree - Required
• Bachelor's Degree Clinical Field - Preferred

Experience Qualifications

• At least five (5) years related professional experience in a hospital patient financial services function - Required and
• Experience with coding, billing and CDM maintenance - Required or
• At least five (5) years related professional experience in a hospital patient financial services function - Required
• At least three (3) years prior supervisory experience - Preferred
• Clinical experience - Preferred

Skills and Abilities

• Experience with coding, billing and CDM maintenance (Required proficiency)
• Knowledge of SMS billing system (Required proficiency

Children's Hospital of Philadelphia