Charge Description Master (CDM) Analyst

Position Summary / Career Interest

The Charge Description Master (CDM) Analyst is responsible for maintaining and optimizing the hospital's Charge Description Master to ensure accurate, compliant, and efficient billing processes. The analyst collaborates with clinical, coding and billing teams to review and update charge data, analyze financial impacts and ensure the integrity of the charge structure in accordance with regulatory standards and organizational policies.

Responsibilities and Essential Job Functions

• Maintains all inpatient, outpatient and physician charge description documents to ensure that all items are a direct reflection of chargeable and billable services; initiates, coordinates, monitors, reviews, analyzes and implements requests to add, change or delete CDM items as appropriate; improves efficiency by eliminating duplicate, inactive or non-compliant charges, thus decreasing the potential for an inappropriate charge being utilized.
• Research billing guidelines to maintain CDM compliance with Medicare and Medicaid standards; reviews and updates documents concerning procedural and coding changes and initiates action to update the hospital charge description master as necessary; performs data quality reviews on individual department charge descriptions to ensure compliance with all payer mandates and reporting requirements.
• Performs CDM quality control and troubleshooting activities; performs systematic reviews of system-generated reports to monitor charging practices and identifies potential problems; recommends workflow and other process changes to address charging problems or deficiencies; audits health care provider progress notes to ensure that appropriate charges are being reported on patient billing documents; researches and resolves complex billing issues involving rejected charges; analyzes file data for evidence of deficiencies in controls, duplication, fraud, process breakdowns, or compliance.
• Maintains and / or modifies departmental charge documents to reflect current CDM choices.
• Research industry trends regarding pricing policies and recommends adjustments to pricing strategies and policies; confers with Hospital management to analyze CDM billing processes, to identify root causes of denials / underpayments, and to analyze new third-party payment requirements.
• Implements CDM data entry or upload maintenance requests; works with information systems staff to ensure that the appropriate CDM information is properly loaded and placed on the claims.
• Coordinates and / or oversees projects and processes as assigned; prepares reports, studies, analyses, and other documents as assigned; presents findings to individuals and / or groups as required.
• Performs other duties as assigned.
• Works effectively with Revenue Integrity Clinical Nurse Auditor, CDM, and Pricing Committees.
• Demonstrates knowledge of Coding Guidelines and Conventions (CPT / HCPCS, ICD-10-CM / PCS).
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

Preferred Education and Experience

Preferred Licensure and Certification

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

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