[Hiring] Charge Review Specialist Senior @Central Health

Role Description

The Charge Review Specialist Senior works as 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 are carried 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

• Ensure timely and accurate processing of claims in a manner consistent with company processes and procedures and industry best practices.
• Under the direction of the Revenue Integrity Manager, determine the correct sequence of ICD 10, CPT, and HCPCS codes.
• Answer coding questions from providers and staff, assisting in definition and guidance of all applicable regulatory standards and correct coding initiatives.
• Analyze and evaluate provider coding to ensure standards are adhered to and provide guidance to providers as needed.
• Maintain strict confidentiality; comply with HIPAA guidelines/regulations and industry standards.
• Meet daily productivity goals.
• Participate actively as a member of the Revenue Cycle Team to ensure all daily activities are completed and company goals are achieved.
• Develop, implement, and seek improvement in policies and procedures for charge review.
• 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.
• Document all communication and activities in billing notes for clear communication.
• Demonstrate willingness to participate in initiatives impacting the organization.
• Perform any other duties as needed to drive the vision, fulfill the mission, and abide by the values of the organization.

Qualifications

• High school diploma or GED.
• 4 years of relevant healthcare revenue or medical billing cycle experience, including coding.
• 4 years of experience working with FQHC billing and revenue cycle activities (preferred).
• Holds and maintains certification as one of the following:
  • Certified Coding Specialist (CCS) through governing body AHIMA.
  • Certified Coding Specialist - Physician (CCS-P) through governing body AHIMA.
  • Certified Professional Coder (CPC) through governing body AAPC.
  • Certified Professional Coder - Hospital (CPC-H) through governing body AAPC.

Requirements

• Thorough knowledge of billing and coding policies and procedures.
• Knowledge of ICD 10, CPT, HCPCS, and modifiers.
• Able to provide high-quality service in a professional and courteous manner.
• 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.
• 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.
• 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.
• Excellent verbal and written communication skills.
• Must possess a strong work ethic and high level of professionalism.
• Analytical and problem-solving skills, with the ability to use data to identify patterns and trends.
• Demonstrated knowledge of medical terminology, anatomy, and insurance processes.
• Experience with EPIC PM/EMR system is preferred but not required.

Benefits