Revenue Integrity Manager, CDM Operations

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The Wilshire Group

SiteLinkedInTodas as Vagas

11 - 50 funcionários

⚕️ Seguro de Saúde

🏢 Corporativo

Healthcare Insurance • Consulting • Enterprise

O Grupo Wilshire é uma empresa de consultoria que se especializa em otimizar operações do ciclo de receita e soluções de TI para a indústria de saúde. Eles oferecem serviços em acesso ao paciente, gestão de informações de saúde, integridade de receitas e faturamento para ambientes hospitalares e profissionais. A empresa foca em aprimorar as experiências financeiras ao colaborar com os clientes para resolver desafios complexos na interseção entre operações e tecnologia. O Grupo Wilshire dedica-se a ajudar as organizações a maximizar seus investimentos em prontuários eletrônicos de saúde (EHR) e a melhorar o reconhecimento de receita e a otimização de fluxos de trabalho, garantindo resultados consistentes e comprovados.

Descrição

• Lead the strategic oversight, maintenance, and optimization of the Charge Description Master (CDM) • Partner with operational, finance, clinical, compliance, and IT teams to improve revenue integrity processes • Monitor and maintain compliance with CPT, HCPCS, ICD-10, CMS, and payer requirements • Conduct CDM audits and identify opportunities for charge capture accuracy and reimbursement improvement • Manage annual and ongoing code set updates, pricing reviews, and regulatory changes • Analyze reimbursement trends and recommend operational and pricing enhancements • Support system implementations, upgrades, and integrations impacting CDM workflows, including Epic • Develop best practices and provide guidance to department leaders on CDM governance and charge capture processes • Assist with resolving billing discrepancies, denials trends, and compliance risks • Drive process improvement initiatives that enhance operational efficiency and financial performance

🎯 Requisitos

• Bachelor’s degree in Healthcare Administration, Health Information Management, Finance, or related field • 5+ years of experience in Revenue Integrity, CDM management, hospital billing, or healthcare reimbursement • Strong working knowledge of CPT, HCPCS, ICD-10, and payer reimbursement methodologies • Experience working within hospital billing systems and EMR platforms (Epic preferred) • Strong analytical, organizational, and problem-solving skills • Ability to manage multiple priorities in a fast-paced consulting environment

🏖️ Benefícios

• Flexible, remote work environment • Collaborative and highly experienced consulting team • Opportunity to work with nationally recognized healthcare systems • Meaningful, high-impact healthcare projects • Fast-moving environment where your expertise is valued and visible