RCMI Charge Description Master (CDM) Senior Solution Technical Expert (SSTE)

Great Hill Solutions, LLC is part of the Seneca Nation Group (SNG) portfolio of companies. SNG is Seneca Holdings' federal government contracting business that meets mission-critical needs of federal civilian, defense, and intelligence community customers. Our portfolio comprises multiple subsidiaries that participate in the Small Business Administration 8(a) program. To learn more about SNG, visit the website and follow us on LinkedIn.

Our team of talented individuals is what makes us successful. To support our team, we provide a balanced mix of benefits and programs. Your total rewards package includes competitive pay, benefits, and perks, flexible work-life balance, professional development opportunities, and performance and recognition programs. We offer a comprehensive benefits package that includes medical, dental, vision, life, and disability, voluntary benefit programs (critical illness, hospital, and accident), health savings and flexible spending accounts, and retirement 401K plan. One of our fundamental principles is to offer competitive health and welfare benefits to our team members, providing coverage and care for you and your family. Full-time employees working at least 30 hours a week on a regular basis are eligible to participate in our benefits and paid leave programs. We pride ourselves on our collaborative work environment and culture, which embraces our mission of providing financial and non-financial benefits back to the members of the Seneca Nation.

Great Hill is seeking a RCMI Charge Description Master (CDM) Senior Solution Technical Expert (SSTE) in the continental US to support the Defense Health Agency. The objective of this work is to support the DHA Financial Operations, J-8 with capabilities for optimization of revenue cycle efforts to prioritize improvement opportunities, begin reducing work queue backlog in MHS GENESIS, increase clinical workload capture, increase total billed for Third Party Collections (TPC), identify and correct areas where revenue leakage may be occurring, improve enterprise knowledge of workload and revenue capture, and enhance MTF staffs' ability to manage their business and be audit-ready. assist our government healthcare client to optimize Revenue Cycle operations.

Roles and Responsibilities include, but are not limited to:

• Possess skill sets to flawlessly build, maintain, and sustain the master CDM using technology of the governments choice, and ability to remain current with all regulatory changes resulting in code additions, deletions, and modifications.
• Provide education regarding charge input and charge master related items to MHS Business Community personnel.
• Advise the RCM stakeholders on CDM policy and practices to ensure regulatory compliance.
• Professionally interact with identified RCM functional stakeholders within and outside the J8 Directorate to seamlessly implement CDM resolutions to existing and/or future issues or requirement enhancements/optimizations.
• Maintain continuous updates of CDM based on American Medical Association (AMA) and Centers for Medicare and Medicaid (CMS) regulatory releases and Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) revisions.
• Coordinate CPT/HCPCS cost-based price reviews with DHA Uniform Business Office as codes are added, deleted, or modified based on CMS regulatory reports.
• Document and maintain CDM Standard Operating Procedure (SOP) manual and other training materials/user guides with current CDM workflow, pricing guidelines, and validation steps for existing, new, or unique, MHS code descriptions, revenue codes, surgical levels, clinical areas, and other data components, no less than once per quarter based on regulatory updates. In some cases, the CDM SOP may require ad hoc updates if emergency codes are released off cycle.
• Support MHS-specific CDM modifications, additions, and deletions as requested by the DHA or MHS GENESIS client.
• Develop and continually refine a supply item file to serve as the source file for all chargeable supply items, no less than once per quarter.
• Continue to coordinate maintenance of the CHAMPUS Maximum Allowable Charge (CMAC) rate tables within the CDM based on DHA UBO calculated rates using annual Tricare data releases and existing MHS rate structures; along with additional rate tables/prices scheduled required.
• Coordinate utilization of updates to Medical Expense and Performance Reporting System (MEPRS), Comprehensive Ambulatory/Professional Encounter Record (CAPER), Defense Medical Logistics Standard Support (DMLSS), and CHAMPUS Maximum Allowable Charge (CMAC) data sources as defined cost-based and CMAC-based procedure pricing methodologies are calculated by the DHA UBO.
• Coordinate outcomes of DHA UBO analysis of MTF localities at the Parent and Child facility level to construct proposed grouping methodologies based on geographic, workload, resource, or other consistencies to develop a defensible charge table structure.
• Update CDM calculated standard rates (room, tiered surgical services, etc.) based on DoD costs incurred for delivering such services as provided by DHA UBO.
• Coordinate communication effort for DHA leadership and EHR system end users with MHS GENESIS Charge Services Solution Owner Team and respective DHA Functional Teams for CDM changes no later than 15 days prior to change release within MHS GENESIS that include but are not limited to pricing updates, billing decision updates, rev code, and CPT/HCPCS code changes.
• Maintain existing business process and methodology for 100 Character Descriptions for all active and obsolete codes, while updating list in line with all regulatory updates.
• Create and maintain American Dental Association (ADA) Current Dental Terminology (CDT) code table and descriptions within the CDM as required.

Basic Qualifications:

• Possess Oracle/Cerner EHR CDM build and configuration expertise for medical, pharmaceutical, and dental services. CDM SSTEs must have no less than four (4) years’ experience with large scale enterprise CDM build, management, enhancement, and technical knowledge/understanding working with electronic CDM management tools. Less than four (4) years may be accepted with review and final determination done on an individual basis.
• Requires a Bachelor’s degree in a clinical or healthcare-related field. An Associate degree combined with an additional five (5) years of Revenue Cycle experience may be substituted for the Bachelor’s degree.
• Must have no less than five (5) years of Medical Coding experience for like size healthcare organizations with current Medical Coding Certification (e.g.  American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), etc.). Less than five (5) years may be accepted with review and final determination done on an individual basis.
• Medical billing experience not required; however, experience is preferred.
• Can achieve a Favorable Suitability Adjudication, based on a Tier 2 background investigation.
• Due to the nature of the government contract requirements and/or clearance requirements, US citizenship is required.
• Experience with ticket queuing system issue resolution processes.
• Possess and maintain tools for proper and compliant charge master input, including but not limited to; government approved, fully vetted, and validated electronic CDM application.
• Demonstrate an ability to utilize and pull from existing MHS data systems to populate the CDM.
• Possess CDM auditing expertise to ensure defensible charges/prices.
• Possess an understanding of medical record coding and how the CDM assists the medical record coders in accurately coding patient encounters.
• Incorporate AMA/CMS code adds, modifications, and obsolete codes into the CDM.
• Continue to support the on-going maintenance of annual updates from AMA code sets, and quarterly updates based on payer interpretations and changes to activate/inactivate CDM line items by site.
• Microsoft Office 365 proficiency (Excel, Word, PowerPoint).
• Excellent oral, written, and interpersonal skills.

Desired Skills:

• Possess a Favorable Suitability Adjudication, based on a current Tier 2 background investigation.
• Possess a DHA issued Common Access Card (CAC)
• Substantial experience within the Military Health System (MHS) environment and requisite knowledge of revenue cycle operations.
• Ability to use various software applications and tools to perform Revenue Cycle functions, such as Electronic Health Record systems (Oracle/Cerner Patient Accounting Module (CPAM)), billing/claim solutions/systems (Electronic Claims Clearinghouse (SSI), 3M 360 Encompass Institutional & Professional Coding, Claim Scrubber Edits (Alpha ii), Patient Statements/Letters (RevSpring)), data analytics tools/repositories (Excel, Power BI, SAS, Tableau, HealtheAnalytics), and reports: HealtheAnalytics, Discern Reporting Portal, and Lights On Network, ideally in the MHS environment.