Navigant Charge Description Master (CDM) Manager - Navigant Cymetrix - Lewisville, TX in Lewisville, Texas

Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the Firm primarily serves clients in the healthcare, energy and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at navigant.com.

Navigant Cymetrix unites the strengths of four category-leading companies to address the complexities of today’s healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

Navigant Cymetrix has an exciting opportunity to join its Revenue Integrity team as a remote Charge Description Master (CDM) Manager for Cayuga Medical Center. As a member of the Comprehensive Revenue Cycle Management (CRCM) team, the CDM manager will be responsible for overseeing the overall data quality, regulatory compliance and performance of the CDM. The CDM Manager will work closely with clinical and ancillary leadership to ensure adherence to and compliance with payer, government and internal system regulatory policies and reporting requirements.

Through collaboration between the CRCM project team and client stakeholders, the CDM Manager contributes to continuous process improvements to meet and/or exceed established CRCM Key Performance Indicators (KPI).

Essential Job Functions

  • Demonstrates the ability to make sound, productive, and ethical decisions in the performance of assigned duties.

  • Demonstrates a commitment to quality and excellence.

  • Contributes to team effort by remaining flexible and open minded, maintaining cooperative working relationships, sharing resources and information, and assisting co-workers in time of need.

  • Complies with Navigant Cymetrix and CRCM client policies and procedures.

  • Promotes client customer service through active communication, understanding their needs and concerns, and providing resolution with tact, diplomacy and sensitivity.

Duties and Responsibilities

  • Develops and maintains collaborative working relationship(s) with revenue producing departments, information systems personnel, and finance, compliance and revenue cycle teams.

  • Collaborates with the Navigant-Cymetrix Revenue Integrity Director to establish work priorities and set performance objectives and measures.

  • Oversees and delivers all requested additions, deactivations and other modifications to the CDM file from the requesting department’s leadership and confirms that all requested changes have been made in a timely manner.

  • Collaborates with IT, revenue cycle and/or clinical department stakeholders when aberrant billing issues related to the CDM are discovered to determine their root cause and identify corrective action.

  • Oversees the application of quarterly and annual CPT/HCPCS code updates.

  • As requested by the Navigant-Cymetrix Revenue Integrity Director, participates in periodic revenue cycle related meetings to ensure timely and accurate completion of CDM related agenda items.

  • Establishes the proper communication channels (e.g., assessment and distribution of monthly change reports) and development of responses to CDM related questions from stakeholders.

  • Works with organizational leadership in assessing, redesigning, and maintaining the CDM as changes in reimbursement methods from third party payers occur.

  • Consults with Navigant-Cymetrix and Cayuga Medical Center compliance on identified or suspected regulatory risk.

  • Maintains current working knowledge of federal and state regulations regarding CDM driven data elements and related billing requirements.

  • Maintains knowledge of current health system pricing and mark-up policies and applies this knowledge to requested pricing updates and or new CDM additions.

  • Ensures compliance with the CDM file structure including naming and numbering conventions to improve the utility and stability of the file, especially as new service lines or entities are added to the current structure.

  • Daily review of Revenue Integrity Hold Codes in the billing scrubber/editor in order to:

  • Determine claims assigned for review and correction.

  • Review and correct the daily assigned hold code claims that fail for CCI/NCCI/MUE edits and third party payer Medical Necessity LCD/NCD edits in the hospital’s billing editor.

  • Other duties commensurate with skills and experience as determined by the Director of Revenue Integrity.

  • Bachelor’s degree in Nursing, Health Information Management, Healthcare Finance or a combination of related education and equivalent work experience.

  • Five (5) years’ experience in a hospital based health care setting.

  • Extensive knowledge of revenue cycle processes, medical terminology and CDM related coding and billing procedures. CPC, CCS or COC coding certification.

  • Strong interpersonal, communication, process improvement and CDM management experience.

  • Knowledge, understanding and proper application of Medicare, Medicaid and third-party payer billing and reporting requirements;

  • Hospital medical auditing/review experience preferred.

  • Strong verbal, written and interpersonal communication skills.

  • Word/Excel proficient.

  • Ability to produce accurate, assigned work product within specified time frames.

  • Experience with Meditech Health Information Systems strongly preferred.

  • Strong conceptual, as well as quantitative and qualitative analytical skills

  • Work as a member of a team as well as be a self-motivator with ability to work independently

  • Constantly operates a computer and other office equipment to coordinate work

  • Frequently travels by airplane, train or car as necessary to perform work at another location

  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data

  • Generally works in an office environment

Questions regarding this positon, please contact Chris Rivera (Senior Manager, Talent Acquisition) at (714) 361-6836

Navigant Cymetrix is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.

Navigant will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.