Charge Review Specialist

Description

As a Charge Review Specialist, you will meticulously review and analyze medical charges and claims to ensure accuracy, compliance, and adherence to billing guidelines. Your role is essential in preventing billing errors, identifying discrepancies, and optimizing revenue for our healthcare organization.

Responsibilities:

Charge Validation:

Review and analyze medical documentation, including patient records, encounter forms, and electronic health records.

Verify the accuracy of CPT, HCPCS, and ICD-10 codes assigned to services and procedures.

Ensure that charges submitted for billing are complete and meet all documentation requirements.

Coding Compliance:

Assess coding compliance with federal and state regulations, as well as payer-specific guidelines.

Identify and rectify any coding errors, discrepancies, or unbundling issues.

Collaborate with coding specialists to resolve coding-related discrepancies.

Charge Accuracy:

Validate the appropriateness of charges for services rendered based on medical records.

Confirm that charges match the services provided and the documentation in the patient's file.

Investigate any undercoding or overcoding issues and take corrective action.

Claim Submission:

Collaborate with billing specialists to ensure that corrected charges are accurately resubmitted.

Prepare and maintain documentation related to charge reviews and corrections.

A/R Follow-up:

Monitor and resolve outstanding claims, communicating effectively with payers, and reconciling payments, while contributing to the clinic's ability to continue providing quality healthcare services to our patients.

Requirements

Qualifications:

High school diploma or equivalent; certification in medical coding preferred.

Proven experience in charge review, medical billing, or coding.

Proficiency in using electronic health record (EHR) systems, billing software, and coding tools.

Strong knowledge of medical terminology, CPT, HCPCS, ICD-10 coding, and compliance regulations.

Detail-oriented with exceptional analytical and problem-solving skills.

Excellent communication and teamwork abilities.

Familiarity with HIPAA regulations and patient confidentiality.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.

Must be able to lift up to 15 pounds at times.

Working Conditions:

Work is performed in an office, laboratory, and/or clinic environment. This is a full-time position and full-time is defined as 40 hours per work week. The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management retains the right to add or to change the duties of the position at any time.