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About the Role

The Charge Review Specialist Senior works as part of a centralized Revenue Cycle team to process accurate code assignments for claims and billing data prior to payment and revenue reporting. This role ensures compliance with Medicare, Medicaid, and third-party payer guidelines, reviews provider patient charting for accuracy and adherence to correct coding initiatives, and upholds internal coding policies.

Responsibilities

Ensure timely and accurate processing of claims consistent with company processes, procedures, and industry best practices.
Determine correct sequence of ICD 10, CPT, and HCPCS codes under the direction of the Revenue Integrity Manager.
Answer coding questions from providers and staff, providing guidance on regulatory standards and correct coding initiatives.
Analyze and evaluate provider coding to ensure standards are met and provide guidance as needed.
Maintain strict confidentiality in compliance with HIPAA guidelines and regulations.
Comply with industry standards, regulations, and company policy and procedure for all compliance areas.
Meet daily productivity goals.
Actively participate as a member of the Revenue Cycle Team to assist others, ensure daily activities are completed, and identify continuous improvements.
Develop, implement, and improve policies and procedures for charge review to ensure professional and ethical department activities.
Review documentation for appropriateness based on provider-submitted coding.
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 and concise communication.
Demonstrate willingness to participate in initiatives with a fundamental impact on the organization.
Perform other duties as needed to drive the organization's vision, mission, and values.

Requirements

Thorough knowledge of billing and coding policies and procedures.
Knowledge of ICD 10, CPT, HCPCS, and modifiers for provider coding and billing assignments.
Ability 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 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 multiple assignments, 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-oriented 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 Microsoft Office Suite.
Experience with EPIC PM/EMR system is preferred but not required.

Skills

ICD 10
CPT
HCPCS
HIPAA
Microsoft Office Suite
EPIC PM/EMR

Experience Level

4 years of relevant healthcare revenue or medical billing cycle experience, which includes coding.
4 years of experience working with FQHC billing and revenue cycle activities.

Education Level

High school diploma or GED
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