Revenue Cycle Optimization Consultant

The Revenue Cycle Optimization Consultant is responsible for the review, development, and continual improvement of the Charge Description Master (CDM) across assigned TruBridge clients. This role ensures CDM compliance with federal and state regulations, optimizes charge capture processes, and collaborates with operations teams and clients to ensure Charge master is current and up to date. The Director acts as a subject matter expert (SME) in CDM strategy, ensuring consistent and compliant practices while identifying opportunities to enhance reimbursement and operational efficiency.  This person skillset can be used for current client review as well as external services for a fee to client.

These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job-related duties as required.  Goals and objectives are subject to change.

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. 

Essential Functions:

• Performs CDM reviews and maintenance to ensure CDM is updated timely and accurate in accordance with the CMS quarterly updates.
• Obtains quarterly update files to update the tool used to conduct chargemaster reviews, such as the following:
• Collaborate with Revenue Cycle, Compliance, Clinical Leadership, Finance, and IT to standardize CDM practices and align with enterprise goals.
• Maintains abreast of quarterly OPPS changes as published in the OPPS.  Examples:
• Support CBO annual charge master updates based on CMS, AMA, and payer regulatory changes, including CPT/HCPCS, revenue codes, and billing rules.
• Meets with clients to discuss their worklist of items to be corrected; follows up with clients to ensure corrections are made.
• Educates clients on proper chargemaster maintenance, especially when adding new charge items.  Provides suggestions for identifying proper HCPCS codes, revenue codes, and rate-setting.  Various tools may be used for suggesting rate-setting, such as:
• Utilizes datamining to identify CBO clients having high Original Errors or Denials due to item master errors and conducts review of those clients’ chargemasters to make suggestions to increase clean claim rate and reduce denials.
• Collaborates with Compliance, TBEHR Financial Support, RCM, and CBO to suggest RCM edits, client education, and updates to company documents as the need arises. 
• Establish and monitor KPIs, reporting dashboards, and operational benchmarks for CDM performance.
•  Support pricing transparency, chargemaster publication requirements, and compliance with No Surprises Act and related legislation, as it pertains to the chargemaster.
•  Lead the CDM function during major initiatives such as EHR transitions, acquisitions, or new program launches.

Minimum Requirements:

Education/Experience/Certification Requirements

• Bachelor’s degree in Health Information Management, Healthcare Administration, Finance, or related field (
• 4-7+ years of experience in hospital revenue cycle/CDM management
• Expert knowledge of CPT, HCPCS, ICD-10, revenue codes, and payer-specific billing requirements.
• Deep understanding of CMS regulations, compliance, and hospital reimbursement methodologies.
• Strong leadership, communication, and analytical skills, with the ability to influence at the executive level.

Working Environment/Physical Demands

Working Environment:

• General office environment: Works at a desk in a well-lighted, air-conditioned cubicle/office, with moderate noise levels. 
• Periods of stress may occur.

Physical Demands:

• Activities require a significant amount of sitting at office and work desks and in front of a computer monitor.
• Some walking and standing relative to interaction with other personnel. 

Travel Requirements:

Occasional - 25% or less

Individual Contributor