Revenue Integrity Manager, CDM Operations

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🕒 May 27

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The Wilshire Group

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare Insurance • Consulting • Enterprise

The Wilshire Group is a consultancy firm that specializes in optimizing revenue cycle operations and IT solutions for the healthcare industry. They provide services in patient access, health information management, revenue integrity, and billing for both hospital and professional settings. The firm focuses on enhancing financial experiences by partnering with clients to solve complex challenges at the intersection of operations and technology. The Wilshire Group is dedicated to helping organizations maximize their EHR investments and improve revenue recognition and workflow optimization, ensuring consistent and proven results.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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