Director of Enterprise Charge Description Master

Overview Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job Details The Director of Enterprise Charge Description Master (CDM) provides strategic and operational leadership for the health system’s charge infrastructure, ensuring accuracy, compliance, and alignment with reimbursement and financial performance objectives. Reporting to the Vice President of Revenue Cycle, this role is accountable for the governance, integrity, and optimization of all charge-related activities across the enterprise. This position plays a critical role in driving net revenue performance by ensuring compliant charge capture, defensible pricing strategies, and accurate reimbursement across all care settings. The Director partners closely with Revenue Cycle, Finance, Managed Care, Clinical Operations, IT, and Procurement to standardize processes, mitigate revenue leakage, and support system-wide financial sustainability. In addition, the role leads the evaluation of new services, procedures, and technologies through a multidisciplinary governance structure. This includes assessing reimbursement, cost, and margin implications to inform decision-making and ensure alignment with organizational growth and profitability targets. Key Focus Areas Enterprise CDM governance, standardization, and compliance Strategic pricing and reimbursement optimization Charge capture integrity and revenue leakage prevention Cross-functional alignment with clinical, financial, and operational leaders Financial evaluation of new products, services, and technologies Support of system-wide margin improvement and cash acceleration objectives Duties and Responsibilities CDM Governance, Accuracy, and Compliance Provide enterprise oversight of CDM structure, ensuring accuracy of CPT/HCPCS codes, revenue codes, charge descriptions, and methodologies Ensure compliance with CMS, Medicare transmittals, NCCI edits, OPPS/EAPG, and payer-specific requirements Lead quarterly and annual CDM updates, including regulatory changes (MUEs, Modifier 25, IP-only procedures, NTAP, pass-through devices) Develop and maintain CDM policies, procedures, and audit controls to mitigate compliance risk and revenue leakage Oversee EPIC CDM build integrity across all modules (Willow, Optime, Radiant, EpicCare IP/OP)\ Ensures compliance with the Federal transparency laws including any necessary preparation and submission of charge files and posting of files. Revenue Optimization and Strategic Pricing Lead development and execution of system-wide strategic pricing initiatives,aligning to market conditions and reimbursement methodologies Identify revenue opportunities through charge capture improvement, under-coded services, and reimbursement variance analysis Partner with Managed Care, Revenue Cycle and Finance, ensuring CDM structure is in compliance with payer contract terms (DRG, OPPS, APC, Fee Schedules) Monitor billing accuracy, denial trends, and charge-related revenue leakage and make recommendations for billing alternatives and or modifications to charges, contracts and build. Charge Capture and Operational Integration Ensure CDM changes are operationalized within clinical and departmental workflows Standardize charge capture processes and work queues (CFB, DFB, charge review) to improve clean claim rates and reduce DNB Oversee resolution of CDM related charge errors and EPIC work queue management (error pools, charge reconciliation) Collaborate with Revenue Integrity, HIM, and Clinical departments to ensure alignment between documentation, coding, and charging New Products and Services Governance Active participant in the Enterprise New Products Committee Evaluate new procedures, services, devices, and technologies prior to implementation Collaborate with Patient Access, Managed Care, Billing, Finance, Procurement, and Clinical leadership to ensure: Appropriate coding, charge build, and pricing strategy Coverage, authorization, and reimbursement validation Coding in accordance to payer processing and reimbursement terms Financial viability and margin expectations prior to go-live Monitor post-implementation performance including volume, reimbursement, and margin outcomes Technology and Data Integration Oversee integration and optimization of CDM tools (EPIC, FinThrive, 3M, KnowledgeSource) Partner with IT and DTS to manage system edits, code integration, and automation opportunities Ensure third-partysystems (Radiation Oncology, Cardiology, Laboratory, Blood Bank) align with enterprise CDM structure Develop and maintain reporting and dashboards to monitor CDM performance and revenue impact Leadership and Stakeholder Engagement Serve as enterprise subject matter expert for CDM, charging, and reimbursement Lead cross-functional collaboration across Revenue Cycle, Finance, IT, Managed Care, and Clinical Operations Provide education and training on CDM updates, regulatory changes, and charging practices Drive accountability for compliance, operational performance, and financial outcomes Strong project management skills in the areas of managing and updating workflows, technical documentation, and other associated materials related to large scale implementation projects Excellent written communication, verbal communication, interpersonal, time management, and organizational skills Compliance and Standards Ensure adherence to all Federal, State, and regulatory requirements including Medicare, Medicaid, and HIPAA Maintain compliance with organizational policies, procedures, and security standards Conduct activities consistent with CHS policies and non-discrimination standards Skills and Competencies Advanced knowledge of CPT, HCPCS, ICD-10, DRG, OPPS, APC, and managed care reimbursement methodologies Strong analytical, financial, and strategic pricing capabilities Demonstrated expertise in regulatory compliance and audit risk mitigation Strong project management and organizational skills Excellent written, verbal, and interpersonal communication skills Ability to lead cross-functional teams and influence decision-making at all levels Ability to manage multiple priorities in a fast-paced environment Demonstrated ability to use MS Office and presentation tools as necessary Disclaimer Every effort has been made to make this job description as complete as possible. It does not imply that these are the only duties to be performed. The omission of specific statements does not exclude them from the position if the work is similar, related, or a logical assignment . Position Requirements and Qualifications Education Education Minimum: Bachelor’s Degree in Healthcare Administration, Business, Finance, or related field required (or equivalent experience) Experience 7–10 years of Revenue Cycle experience with functional expertise / hands on ownership of CDM governance, revenue integrity, and reimbursement optimization across multiple care settings (acute, ambulatory, post acute). Demonstrated outcomes improving net revenue, reducing charge lag/leakage and strengthening audit and compliance performance Experience with EPIC (Resolute, Charge Router, Charge Review WQs) with experience leading large scale CDM builds, conversions and pricing initiatives. Payer and Reimbursement expertise across Medicare, Medicaid, Commercial 3 rd party payers: OPPS, Fee Schedules, and value based models Preferred Qualifications Dual competency in coding and revenue integrity (CPT/HCPC/ICD-10) with the ability to translate regulatory requirements into operational CDM strategy. Clinical background (e.g., nursing, allied health, or clinical operations) preferred to support alignment between clinical services, documentation, and charge capture Recognized certifications: RHIA, RHIT, CCS, CPC (or equivalent); advanced certifications in revenue integrity or compliance are a plus Financial acumen with experience in pricing strategy, cost modeling, and margin analysis tied to new services and technology Strong cross functional leadership with a track record of influencing Finance, Managed Care, Clincal Ops, and IT to drive enterprise adoption Work Environment / Location This is a hybrid role requiring a balance of on-site and remote work. Regular on-site presence is expected to support leadership meetings, cross-functional collaboration, and operational workflow assessments across facilities. The role requires flexibility to be on-site as needed to effectively engage with stakeholders and drive enterprise initiatives. PHYSICAL REQUIREMENTS: Sustained high level of mental focus, analytical thinking, and attention to detail required to manage complex, system-wide initiatives and decision-making Role operates in a fast-paced, high-accountability environment with competing priorities, requiring the ability to effectively manage pressure and deliver results Prolonged periods of computer use, including data analysis, reporting, and virtual collaboration Ability to participate in on-site meetings, operational walkthroughs, and cross-functional engagements as needed to support enterprise initiatives Salary Range USD $160,000.00 - USD $225,000.00 /Yr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits. At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth. #J-18808-Ljbffr