Overview

The Charge Review Specialist Senior works a part of a centralized Revenue Cycle team to process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit reviews. Ensures all professional aspects of the assignment of diagnostic and procedural coding is carries out in compliance with applicable Medicare, Medicaid and third-party payer guidelines. Reviews provider patient charting to ensure accuracy as well as adherence to correct coding initiative guidelines. Adheres to internal coding policies and expectations set forth by leadership.

Responsibilities

Essential Duties

(at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):

Primary Accountabilities:

• Ensure timely and accurate processing of claims in a manner that is consistent with company processes and procedures and industry best practices through direct efforts and coordination of other efforts.
• Under the direction of the Revenue Integrity Manager, determines correct sequence of ICD 10, CPT and HCPCS codes.
• Answers coding questions from providers and staff assisting in definition and guidance of all applicable regulatory standards and correct coding initiatives.
• Analyzes and evaluates provider coding to ensure standards are adhered to and provides guidance to providers as needed.
• Maintains strictest confidentiality; to all HIPAA guidelines/regulations; complies with industry standards, regulations, and company policy and procedure for all other compliance areas.
• Meets daily productivity goals.
• Active participation as a member of the Revenue Cycle Team in assisting others as needed to ensure all daily activities are completed, company goals are achieved, and continuous improvements and cost efficiencies are identified and pursued.
• Develop, implement, and consistently seek improvement in policies and procedures for all charge review to ensure department activities are carried out professionally and ethically, patients are treated respectfully, and revenue is optimized.
• Review documentation for appropriateness based on coding submitted by providers.
• Audit claims processed by Charge Review Specialists for quality assurance and guideline adherence.
• Initiate and respond to telephone inquiries from providers, clients and patients.
• Documents all communication and activities in billing notes to assist with clear, concise and accurate communication to all who work with patient billing ledgers and processes.
• Demonstrate a willingness to be an active participant in initiatives that have fundamental impact on the organization.
• Performs any other duties as needed to drive the vision, fulfill the mission, and abide by the values of this organization.

Knowledge/Skills/Abilities:

• Thorough knowledge of billing and coding policies and procedures.
• Knowledge of ICD 10, CPT, HCPCS and modifiers to all provider coding and billing assignments.
• Able to provide service of the highest quality in a professional and courteous manner to our referral sources and patients.
• Proficiency in filing and collecting insurance claims.
• Analytical skills to examine billing information for accuracy and completeness.
• Previous experience with electronic claim filing and practice management software packages.
• Computer literate in current Windows applications – Word, Excel, PowerPoint and Outlook.
• Typing and 10-key proficiency; ability to perform computer and data entry functions.
• Ability to assess and revise processes based on data analytics/evolving information.
• Knowledge of healthcare billing and reimbursement procedures and regulations.
• Basic accounting skills; ability to accurately audit patient accounts.
• Skill to organize and prioritize workload, coordinate many assignments simultaneously and meet deadlines.
• Must be well organized and detail oriented.
• Able to work independently and proactively engage supervisor and coworkers when needed.
• High level of skill at building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research, and information retrieval.
• Excellent verbal and written communication skills.
• Must be detail orientated and have strong organizational skills.
• Must possess a strong work ethic and high level of professionalism.
• Analytical and problem-solving skills, and the ability to use data to identify patterns and trends.
• Demonstrated knowledge of medical terminology, anatomy, and insurance processes.
• Demonstrated proficiency in the use of computer and commonly used software including but not limited to Microsoft Office Suite.
• Experience with EPIC PM/EMR system is preferred but not required.

Qualifications

• MINIMUM EDUCATION: High school diploma or GED
• MINIMUM EXPERIENCE: 4 years of relevant healthcare revenue or medical billing cycle experience, which includes coding.
• PREFERRED EXPERIENCE: 4 years of experience working with FQHC billing and revenue cycle activities.
• REQUIRED CERTIFICATIONS/LICENSURE: Holds and maintains certification as one of the following: 1. Certified Coding Specialist (CCS) through governing body AHIMA 2. Certified Coding Specialist ‐ Physician (CCS‐P) through governing body AHIMA 3. Certified Professional Coder (CPC) through governing body AAPC 4. Certified Professional Coder ‐ Hospital (CPC‐H) through governing body AAPC MINIMUM