Charge Specialist, Revenue Integrity

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Conduct research, gather, analyze, and consolidate information to support operational projects and initiatives.

• Identify potential opportunities, develop solutions, and guide issues to resolution.

• Collaborate on activities aimed at enhancing performance related to program efficiency and patient experience.

• Distribute analytical reports to relevant stakeholders.

• Employ various system applications to conduct analyses, generate reports, and create educational materials.

• Maintain quality, confidentiality, and safety by adhering to established policies, practices, and processes.

• Prepare comprehensive summaries with graphical representations of data that illustrate trends and propose practical solutions.

• Utilize program and operational data to define and showcase progress, ROI, and impacts.

• Ensure accurate CPT/HCPCS documentation for patient billing and provide education to colleagues and ancillary departments regarding correct documentation and coding.

• Execute charge capture in designated Revenue Integrity areas.

• Review charts and clinical documentation to interpret, validate, and/or extract charges.

• Confirm that charges are assigned to the appropriate patient, encounter, date of service, and necessary modifiers.

• Analyze documentation, abstract data, and ensure charges/coding align with AMA and Medicare coding standards.

• Conduct CPT and ICD-10 coding, perform documentation reviews, and manage claim denial reviews.

• Address pre-bill edits including OCE/CCI and DNFB within established key metrics.

• Provide at-elbow support to ancillary departments, including supply-charge validation, duplicate-charge identification, and communication of deficiencies/errors.

• Carry out charge entry, charge approvals, quality charge reviews, modifier appending, and checks on clinical documentation.

• Offer constructive feedback to Revenue Integrity colleagues regarding improvement opportunities.

• Code and/or validate charges for complex service lines along with advanced surgical or specialty coding.

• Educate clinical staff on the importance of accurate and comprehensive documentation for revenue optimization and integrity.

⛳️ Requirements

• Associate’s degree in healthcare, business administration, finance, accounting, or a related field, or equivalent experience may be considered in lieu of a degree.

• RHIA, RHIT, CCS, CPC/COC, AAPC, or other coding credentials are required.

• A minimum of three (3) years of relevant coding and charge control experience in a hospital and/or Physician Practice environment.

• Experience in revenue cycle, billing, coding, and/or patient financial services is essential.

• Demonstrated understanding of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging processes & audits, and clinical billing.

• Proficient knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to charge documentation, capture & billing.

• Familiarity with charge capture, reconciliation, error management operations & overall revenue cycle operations.

• CDC (Healthcare Compliance Certification) is preferred.

• CHRI certification/membership is strongly preferred.

• Understanding of APC, OPPS reimbursement structures, OCE/CCI edits, and DNFB.

• Knowledge of clinical documentation improvement processes is strongly preferred.

• Capability to follow complex tasks through to completion while managing concurrent tasks/projects.

• Proficient in using a computer/other technology while ensuring a safe working environment.

• Ability to lift up to 30 pounds unassisted occasionally.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Opportunities for professional development and continuing education.

• Flexible working hours and remote work options.

• Paid time off and holidays.