Seneca Holdings · 1 day ago
RCMI Charge Description Master (CDM) Senior Solution Technical Expert (SSTE)
United States
Full-time
Remote
Senior Level
5+ years expGreat Hill Solutions, LLC is part of the Seneca Nation Group (SNG) portfolio of companies. They are seeking a RCMI Charge Description Master (CDM) Senior Solution Technical Expert (SSTE) to support the Defense Health Agency in optimizing revenue cycle operations and improving workload capture for healthcare clients.
FinanceBankingFinTechProperty & Casualty InsuranceFinancial ServicesInsurance
No H1B
U.S. Citizen Only
Responsibilities
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
Qualification
Required
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
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
Preferred
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
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
Benefits
Medical
Dental
Vision
Life
Disability
Voluntary benefit programs (critical illness, hospital, and accident)
Health savings and flexible spending accounts
Retirement 401K plan
Company
Seneca Holdings
Seneca Holdings is the investment arm of the Seneca Nation of Indians, and has unique sovereign advantages that help to create value.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
J
Jeffrey Ellis
Chief Executive Officer
Recent News
Rochester Business Journal
2025-08-08
Company data provided by crunchbase