"Alerted.org

Job Overview

**Job Summary** :

The Revenue Integrity CDM and Pricing Program Specialist serves as a key technical and analytical expert responsible for ensuring the accuracy, compliance, and strategic alignment of Fairview’s charge description master (CDM) and pricing structures. This role conducts ongoing research, benchmarking, and analysis to establish, validate, and maintain appropriate pricing across all service lines in collaboration with Payer Relations, Finance, and operational leaders.

The Specialist proactively identifies pricing and charge capture outliers, monitors trends in reimbursement and regulatory guidance, and supports the development of sustainable, compliant pricing methodologies. Acting as a bridge between technical systems and business strategy, this position ensures that pricing and CDM data integrity support organizational goals of transparency, compliance, and financial stewardship.

Key Responsibilities:

+ Leads and coordinates comprehensive analysis and maintenance of the CDM within the Epic EHR system.

+ Ensures alignment with CPT/HCPCS coding standards, NUBC guidelines, revenue codes, payer requirements, and regulatory mandates.

+ Partners with Payer Relations to shape enterprise pricing strategies that balance financial goals, market competitiveness, and patient affordability.

+ Identifies and communicates emerging risks or opportunities in pricing application and recommends sustainable solutions.

+ Supports, cross-functional initiatives that integrate CDM and pricing strategies to identify, implement and optimize revenue capture and maintain compliant pricing structures.

+ Collaborates with Payer Relations and other stakeholders to Analyze system-wide CDM and pricing system configurations and operational workflows ensuring alignment and standardization across the organization

+ Ensures that project requests and system changes are implemented effectively and in compliance with applicable standards.

+ Identifies, documents and ensures structural requirements, charging mechanisms, and reimbursement impacts within the Epic system are implemented and optimized?

+ Identifies, promotes, develops and maintains standardized CDM and Pricing workflows, tools and reference materials; provides education and feedback to ensure consistent application across all team members.

+ Fosters strong partnerships to ensure revenue changes, pricing, other are aligned and accurate with Revenue Cycle, clinical departments, IT, and Finance to support enterprise-wide alignment.

Job Expectations:

As a key expert in charge capture and pricing strategy, the Revenue Integrity CDM and Pricing Program Specialist is responsible for ensuring compliant, accurate, and optimized revenue practices across the organization. The core responsibilities are as follows:

+ **CDM and Pricing Maintenance**

+ Sustain an integrated CDM and pricing structure that supports compliant and efficient charge setup.

+ Ensure alignment with regulatory requirements and internal standards.

+ **Analytical Leadership**

+ Conduct deep-dive analyses of charging workflows, pricing models, and revenue data.

+ Identify strategic opportunities such as pricing misalignments, charge capture inefficiencies, or reimbursement risks that affect financial performance; compiles findings and recommends corrective or optimization strategies for leadership review and decision-making.

+ **Regulatory Expertise**

+ Maintain expert-level knowledge of CPT/HCPCS coding and pricing regulations.

+ Research, interpret, and lead the implementation of complex regulatory changes across CDM and pricing systems.

+ **Change Management & Communication**

+ Serve as the subject matter expert for CDM and pricing.

+ Communicate and manage system and process changes to ensure stakeholder alignment and operational readiness.

+ **Cross-Functional Collaboration**

+ Partner with stakeholders to proactively scope and launch integrated projects addressing charging and pricing risks.

+ Advance revenue integrity through strategic collaboration and project execution.

+ **Technical Support & Issue Resolution**

+ Act as the primary resource for resolving escalated technical and process issues related to CDM and pricing.

+ Provide specialized guidance to internal teams and business partners.

Organizational Expectations:

This role also supports the organization’s broader mission and values through the following behaviors:

+ **Compliance and Learning**

+ Completes all required training and learning activities relevant to the role.

+ Maintains up-to-date knowledge of applicable laws, regulations, policies, and procedures.

+ **Culture and Innovation**

+ Fosters a culture of continuous improvement, efficiency, and innovative thinking.

+ Performs other duties as assigned to support organizational goals.

Required Qualifications

+ B.S./B.A. in applicable field. Four (4) years of applicable experience may substitute for a bachelor’s degree

+ 5 years of direct CDM Experience or

+ 5 years in Finance, Accounting, or related healthcare revenue position

+ Requires current Epic Resolute Certification(s) in one or more of the following Epic applications:

+ Resolute Hospital Billing Charging Epic Upon Hire or

+ Resolute Hospital Billing Claims Epic Upon Hire or

+ Resolute Professional Billing Charging Epic Upon Hire or

+ Resolute Professional Billing Claims Epic Upon Hire

Preferred Qualifications

+ Masters in Business Admin Master’s degree in finance, Accounting, or related healthcare field

+ 10 years of applicable Revenue Cycle experience

+ Possess one or more of the following professional industry certifications:

+ Registered Health Info Tech (RHIT) AHIMA Upon Hire or

+ Registered Health Info Admin (RHIA) AHIMA Upon Hire or

+ Certified Coding Specialist (CCS) AHIMA Upon Hire or

+ Certification in Healthcare Revenue Integrity (CHRI) NAHRI Upon Hire or

+ Certified Professional Coder (CPC) AAPC Upon Hire

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.

EEO Statement

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status