Reimbursement and CDM Manager, Day Shift, Reimbursement

Support CenterIf you are a current Adventist HealthCare employee, please click this link to apply through your Workday account.Adventist HealthCare seeks to hire an experienced Reimbursement and CDM Manager for our Reimbursement Department who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing.As a Reimbursement and CDM Manager, you will:• Monitor GBR performance, unit rate compliance, and reimbursement trends for all AHC entities subject to HSCRC and CMMI/AHEAD requirements; recommend and implement pricing adjustments consistent with regulatory requirements and AHC strategy.• Prepare comprehensive monthly reimbursement and revenue packets, including earned revenue recognition, rate control reconciliation, volume analysis, budget variance analysis, performance dashboards, and the monthly journal entry for Accounting.• Provide enterprise oversight of the Charge Description Master (CDM), including review, approval, implementation, and maintenance of charge codes, pricing, revenue codes, CPT/HCPCS codes, modifiers, units, descriptions, and other billing components. Partner with Revenue Integrity, Revenue Cycle, Clinical Departments, Compliance, Reimbursement, and Information Technology to support accurate charge capture, compliant charging practices, and alignment with reimbursement strategy. Participate in multidisciplinary CDM governance, routine CDM and charge-capture audits, annual coding updates, and corrective action activities. Monitor regulatory changes affecting charging and reimbursement, and participate in Epic implementation, conversion, testing, upgrades, and optimization related to charging workflows, pricing, and CDM functionality.• Schedule and download monthly volume and revenue reports for HSCRC reporting; collaborate with Data Engineering and Information Technology to improve report accuracy, controls, and automation.• Prepare quarterly HSCRC reporting, including case mix reconciliation, denials, Uncompensated Care (UCC), and other required regulatory submissions.• Perform detailed reviews and budget reconciliations of HSCRC rate orders; identify discrepancies and collaborate with internal and external stakeholders to validate rate orders and resolve issues.• Prepare workpapers supporting the HSCRC Annual Filing, Medicare Cost Report, HSCRC Special Audit, and other reimbursement filings for all entities; coordinate with external auditors and regulatory agencies as needed for issue resolution.• Prepare in collaboration with Managed Care and other stakeholders, the annual CMS Hospital Price Transparency files for all AHC entities and support ongoing compliance with applicable disclosure requirements.Qualifications include:• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or a related field required.• Five (5) or more years of progressively responsible experience in healthcare reimbursement, hospital finance, revenue cycle, revenue integrity, or Charge Description Master management. Maryland HSCRC reimbursement and regulatory reporting experience strongly preferred.• Prior leadership, project leadership, or experience coordinating multidisciplinary teams preferred; direct supervision of Revenue Integrity is not required.• Knowledge and experience with HSCRC reimbursement methodologies, Global Budget Revenue, Maryland rate setting, and regulatory reporting.• Knowledge of Medicare reimbursement, hospital charging practices, CDM maintenance, pricing, CPT/HCPCS codes, revenue codes, and charge governance.• Demonstrated ability to partner with Revenue Integrity and operational teams on charge-capture accuracy, compliance, and process improvement.• Epic Resolute Hospital Billing and Epic CDM experience preferred.• Experience supporting an Epic implementation, conversion, testing, upgrade, or optimization project.• Experience with CMS Hospital Price Transparency, Medicare Cost Reports, Power BI, and the CMMI AHEAD Model.Work Schedule:Employment Type: Full-timeHours per Week: 40 hours/weekTypical Daily Schedule: 8 am-5 pm Monday through FridayShift Type: Day Shift-Hybrid ScheduleHoliday Requirements: Follow the company holiday calendarPay Range:$105,664.42 - $158,496.00If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.Under the Fair Labor Standards Act (FLSA), this position is classified as:United States of America (Exempt)At Adventist HealthCare our job is to care for you.We do this by offering:Work life balance through nonrotating shiftsRecognition and rewards for professional expertiseFree Employee parkingMedical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hireEmployer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)Paid Time OffEmployer retirement contribution and match after 1-year of eligible employment with a 3-year vesting periodVoluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insuranceSubsidized childcare at participating childcare centersTuition ReimbursementEmployee Assistance Program (EAP) supportAs a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.Join the Adventist HealthCare team today, apply now to be considered!COVID-19 VaccinationAdventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.Tobacco and Drug StatementTobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).Equal Employment OpportunityAdventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law.Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants’ religious beliefs.Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office. #J-18808-Ljbffr Adventist HealthCare