Jul 11
Unspecified
Mid Level Career (5+ yrs experience)
Occasional travel
Healthcare and Science
Falls Church, VA•San Antonio, TX
Blue Iris Tech is seeking a highly skilled Charge Description Master (CDM) Senior Solution Technical Expert (SSTE) to provide support to the Defense Health Agency’s Financial Operations Division. The objective of this role is to help DHA optimize revenue cycle performance by reducing MHS GENESIS work queue backlog, improving clinical workload capture, increasing Third Party Collections (TPC), identifying revenue leakage, and enhancing the audit-readiness and business acumen of Military Treatment Facility (MTF) staff.
Key Responsibilities include, but are not limited to:
Build, maintain, and sustain the master CDM using government-selected technology, ensuring compliance with regulatory code updates (additions, deletions, modifications).
Educate MHS Business Community personnel on CDM-related topics and charge input procedures.
Provide expert guidance on CDM policies and practices to Revenue Cycle Management (RCM) stakeholders to ensure regulatory compliance.
Collaborate with RCM stakeholders across and beyond the J8 Directorate to implement CDM resolutions and enhancements.
Maintain up-to-date CDM content in alignment with AMA, CMS, CPT, and HCPCS updates.
Coordinate pricing reviews of CPT/HCPCS codes with the DHA Uniform Business Office (UBO) based on CMS regulatory changes.
Develop and maintain a comprehensive CDM Standard Operating Procedure (SOP) manual, user guides, and training materials. SOPs must be updated quarterly or as needed based on regulatory or emergency code releases.
Support MHS GENESIS-specific CDM modifications, including code additions and deletions, as requested by DHA or the EHR client.
Maintain and refine a supply item file for all chargeable supplies, updated quarterly.
Manage CMAC rate table updates within the CDM based on DHA UBO data and TRICARE annual releases.
Coordinate cost-based and CMAC-based pricing using MEPRS, CAPER, DMLSS, and CMAC data sources as defined by DHA UBO methodologies.
Assist in developing charge structures and defensible pricing methodologies based on locality, workload, and resource analysis at MTF Parent and Child levels.
Update CDM standard rates (e.g., room charges, surgical tiers) based on actual DoD service delivery costs.
Serve as liaison for communicating CDM changes to MHS GENESIS Charge Services Solution Owner Team, DHA Functional Teams, and system end users. Ensure changes (e.g., pricing, billing decisions, CPT/HCPCS codes) are communicated no later than 15 days prior to system release.
Maintain and update 100-character code descriptions for all active and obsolete codes in accordance with regulatory guidance.
Create and maintain the American Dental Association (ADA) Current Dental Terminology (CDT) code table and related descriptions within the CDM.
Qualifications
Required Qualifications:
Must be able to obtain and maintain a Favorable Suitability Adjudication based on a Tier 2 background investigation.
U.S. citizenship is required due to federal contract requirements.
Bachelor’s degree in a clinical or healthcare-related fiel. An Associate degree combined with an additional five (5) years of Revenue Cycle Management experience may substitute for the Bachelor's degree.
Minimum of four (4) years of experience supporting large-scale enterprise CDM build, management, enhancement, and technical configuration using electronic CDM management tools. Experience below four years may be considered on a case-by-case basis.
Minimum of five (5) years of medical coding experience in a healthcare organization of similar size and complexity. Must possess a current Medical Coding Certification from a recognized authority (e.g., AAPC, AHIMA). Experience below five years may be considered on an individual basis.
Demonstrated expertise in Oracle/Cerner Electronic Health Record (EHR) Charge Description Master (CDM) build and configuration for medical, pharmaceutical, and dental services.
Experience with ticket queuing systems and issue resolution processes.
Ability to use government-approved, validated electronic CDM applications and tools to ensure compliant and accurate CDM input.
Demonstrated experience pulling and utilizing data from existing Military Health System (MHS) data sources to support CDM population.
Proficient in CDM auditing to ensure charge/pricing defensibility and compliance.
Strong understanding of medical record coding and how the CDM supports accurate patient encounter coding.
Ability to incorporate AMA/CMS code additions, modifications, and obsolete codes into the CDM.
Ongoing support for annual AMA code set updates and quarterly payer-driven changes to activate/inactivate CDM line items by site.
Proficiency in Microsoft Office 365, including Excel, Word, and PowerPoint.
Excellent oral, written, and interpersonal communication skills.
Desired Qualifications:
Medical billing experience preferred but not required.
Experience working within the Military Health System (MHS) and a thorough understanding of MHS revenue cycle operations.
Familiarity with software applications and tools used in revenue cycle functions, including:
Electronic Health Record systems: Oracle/Cerner CPAM
Billing/claim systems: SSI Clearinghouse, 3M 360 Encompass, Alpha II Claim Scrubber, RevSpring (Patient Statements)
Data analytics and reporting tools: Excel, Power BI, SAS, Tableau, HealtheAnalytics, Discern Reporting Portal, Lights On Network
Key Responsibilities include, but are not limited to:
Build, maintain, and sustain the master CDM using government-selected technology, ensuring compliance with regulatory code updates (additions, deletions, modifications).
Educate MHS Business Community personnel on CDM-related topics and charge input procedures.
Provide expert guidance on CDM policies and practices to Revenue Cycle Management (RCM) stakeholders to ensure regulatory compliance.
Collaborate with RCM stakeholders across and beyond the J8 Directorate to implement CDM resolutions and enhancements.
Maintain up-to-date CDM content in alignment with AMA, CMS, CPT, and HCPCS updates.
Coordinate pricing reviews of CPT/HCPCS codes with the DHA Uniform Business Office (UBO) based on CMS regulatory changes.
Develop and maintain a comprehensive CDM Standard Operating Procedure (SOP) manual, user guides, and training materials. SOPs must be updated quarterly or as needed based on regulatory or emergency code releases.
Support MHS GENESIS-specific CDM modifications, including code additions and deletions, as requested by DHA or the EHR client.
Maintain and refine a supply item file for all chargeable supplies, updated quarterly.
Manage CMAC rate table updates within the CDM based on DHA UBO data and TRICARE annual releases.
Coordinate cost-based and CMAC-based pricing using MEPRS, CAPER, DMLSS, and CMAC data sources as defined by DHA UBO methodologies.
Assist in developing charge structures and defensible pricing methodologies based on locality, workload, and resource analysis at MTF Parent and Child levels.
Update CDM standard rates (e.g., room charges, surgical tiers) based on actual DoD service delivery costs.
Serve as liaison for communicating CDM changes to MHS GENESIS Charge Services Solution Owner Team, DHA Functional Teams, and system end users. Ensure changes (e.g., pricing, billing decisions, CPT/HCPCS codes) are communicated no later than 15 days prior to system release.
Maintain and update 100-character code descriptions for all active and obsolete codes in accordance with regulatory guidance.
Create and maintain the American Dental Association (ADA) Current Dental Terminology (CDT) code table and related descriptions within the CDM.
Qualifications
Required Qualifications:
Must be able to obtain and maintain a Favorable Suitability Adjudication based on a Tier 2 background investigation.
U.S. citizenship is required due to federal contract requirements.
Bachelor’s degree in a clinical or healthcare-related fiel. An Associate degree combined with an additional five (5) years of Revenue Cycle Management experience may substitute for the Bachelor's degree.
Minimum of four (4) years of experience supporting large-scale enterprise CDM build, management, enhancement, and technical configuration using electronic CDM management tools. Experience below four years may be considered on a case-by-case basis.
Minimum of five (5) years of medical coding experience in a healthcare organization of similar size and complexity. Must possess a current Medical Coding Certification from a recognized authority (e.g., AAPC, AHIMA). Experience below five years may be considered on an individual basis.
Demonstrated expertise in Oracle/Cerner Electronic Health Record (EHR) Charge Description Master (CDM) build and configuration for medical, pharmaceutical, and dental services.
Experience with ticket queuing systems and issue resolution processes.
Ability to use government-approved, validated electronic CDM applications and tools to ensure compliant and accurate CDM input.
Demonstrated experience pulling and utilizing data from existing Military Health System (MHS) data sources to support CDM population.
Proficient in CDM auditing to ensure charge/pricing defensibility and compliance.
Strong understanding of medical record coding and how the CDM supports accurate patient encounter coding.
Ability to incorporate AMA/CMS code additions, modifications, and obsolete codes into the CDM.
Ongoing support for annual AMA code set updates and quarterly payer-driven changes to activate/inactivate CDM line items by site.
Proficiency in Microsoft Office 365, including Excel, Word, and PowerPoint.
Excellent oral, written, and interpersonal communication skills.
Desired Qualifications:
Medical billing experience preferred but not required.
Experience working within the Military Health System (MHS) and a thorough understanding of MHS revenue cycle operations.
Familiarity with software applications and tools used in revenue cycle functions, including:
Electronic Health Record systems: Oracle/Cerner CPAM
Billing/claim systems: SSI Clearinghouse, 3M 360 Encompass, Alpha II Claim Scrubber, RevSpring (Patient Statements)
Data analytics and reporting tools: Excel, Power BI, SAS, Tableau, HealtheAnalytics, Discern Reporting Portal, Lights On Network
group id: 91140005
