Revenue Integrity & CDM Operations Manager

Responsibilities

• 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

• 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 and physician billing (Epic required)
• Strong analytical, organizational, and problem-solving skills
• Ability to manage multiple priorities in a fast-paced consulting environment

Preferred Qualifications

• RHIA, RHIT, CPC, CCS, or similar certification
• Experience supporting large healthcare systems or consulting engagements
• Advanced Excel, reporting, or data analysis skills
• Experience leading charge capture optimization or revenue integrity initiatives

About the Company

At The Wilshire Group, we partner with healthcare organizations across the country to solve complex revenue cycle and operational challenges. As a boutique consulting firm, we bring deep expertise, strategic thinking, and hands-on collaboration to every engagement.