Charge Entry/Coder

Description

Job Title: Charge Entry Specialist

Job Summary:  

The Charge Entry Specialist / Certified Medical Biller & Coder is responsible for accurate charge capture, coding review, and claim preparation to ensure timely and compliant reimbursement. This role requires strong attention to detail and the ability to critically evaluate physician documentation, identify missing or inaccurate charges, and resolve billing discrepancies before claims are submitted.

Key Responsibilities:    

• Review physician documentation and accurately assign CPT, ICD-10, HCPCS, and modifier coding.
• Enter and verify charges for office visits, procedures, injections, diagnostic services, and durable medical equipment.
• Reconcile charges against schedules, encounters, and operative reports to ensure complete revenue capture.
• Analyze documentation for missing, inconsistent, or billable services that may impact reimbursement.
• Research and resolve charge, coding, claim discrepancies and claim rejections.
• Collaborate with physicians and clinical staff to obtain clarification on documentation when needed.
• Identify trends that may lead to denials, missed charges, or revenue leakage.
• Maintain compliance with payer, Medicare, Medicaid, and HIPAA guidelines.
• Assist patients with billing questions and explain charges and EOBs as appropriate.
• Assist in analyzing denials and help support the appeal process to maximize reimbursement
• Support departmental quality, audit, and process improvement initiatives.
• Requires regular and consistent attendance. 

Requirements

Skills and Qualifications:

Required

• High School Diploma or GED.
• Certified Professional Coder (CPC) certification required.
• Must also hold either a Certified Orthopedic Surgery Coder (COSC) certification or Certified Coding Specialist (CCS) certification.
• Minimum 2 years of medical billing, coding, or charge entry experience.
• Working knowledge of CPT, ICD-10, HCPCS coding, medical terminology, and insurance billing requirements.
• Strong analytical, problem-solving, and critical thinking skills.
• Ability to work independently and manage multiple priorities.

Preferred

• Orthopedic, spine, surgical, or ambulatory surgery center billing experience.
• Experience viewing physician documentation for coding accuracy.
• Knowledge of Medicare and commercial payer reimbursement guidelines.

What Success Looks Like

The ideal candidate is more than a data-entry specialist. They understand how physician documentation translates to reimbursement, can identify missing or inaccurate charges, investigate issues independently, and think critically to ensure compliant revenue capture and clean claims. This individual takes ownership, asks questions, and proactively resolves problems before they become denials.

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