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Revenue Integrity Manager, CDM Operations
The Wilshire GroupRevenue Integrity & CDM Operations Manager leading Charge Description Master strategy at The Wilshire Group. Focusing on compliance initiatives and collaboration across various teams to enhance revenue cycles.
ATS Keywords
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Hard Skills
Charge Description Master (CDM)CPTHCPCSICD-10revenue integrityhospital billinghealthcare reimbursementbilling discrepanciescompliance monitoringpricing reviews
Soft Skills
analytical skillsorganizational skillsproblem-solving skillsprocess improvementstrategic oversightguidancecollaborationmulti-taskingleadershipcommunication
Tools & Technologies
Epichospital billing systemsEMR platforms
Certifications & Qualifications
Bachelor’s degree in Healthcare AdministrationBachelor’s degree in Health Information ManagementBachelor’s degree in Finance
Industry Keywords
reimbursement trendscharge capture accuracycompliance risksregulatory changespayer requirementsCDM auditsoperational efficiencyfinancial performanceconsulting environment
About the role
Key responsibilities & impact- Lead the strategic oversight, maintenance, and optimization of the Charge Description Master (CDM)
- Partner with operational, finance, clinical, compliance, and IT teams to improve revenue integrity processes
- Monitor and maintain compliance with CPT, HCPCS, ICD-10, CMS, and payer requirements
- Conduct CDM audits and identify opportunities for charge capture accuracy and reimbursement improvement
- Manage annual and ongoing code set updates, pricing reviews, and regulatory changes
- Analyze reimbursement trends and recommend operational and pricing enhancements
- Support system implementations, upgrades, and integrations impacting CDM workflows, including Epic
- Develop best practices and provide guidance to department leaders on CDM governance and charge capture processes
- Assist with resolving billing discrepancies, denials trends, and compliance risks
- Drive process improvement initiatives that enhance operational efficiency and financial performance
Requirements
What you’ll need- Bachelor’s degree in Healthcare Administration, Health Information Management, Finance, or related field
- 5+ years of experience in Revenue Integrity, CDM management, hospital billing, or healthcare reimbursement
- Strong working knowledge of CPT, HCPCS, ICD-10, and payer reimbursement methodologies
- Experience working within hospital billing systems and EMR platforms (Epic preferred)
- Strong analytical, organizational, and problem-solving skills
- Ability to manage multiple priorities in a fast-paced consulting environment
Benefits
Comp & perks- Flexible, remote work environment
- Collaborative and highly experienced consulting team
- Opportunity to work with nationally recognized healthcare systems
- Meaningful, high-impact healthcare projects
- Fast-moving environment where your expertise is valued and visible