Charge Integrity Coordinator - Revenue Integrity

LCMC Health•Louisiana Childrens Medical Center - Remote, LA

1d•Onsite

About The Position

This position works closely with Revenue Cycle Service, Clinical Service lines, Information Technology and other departments to resolve charging issues or denials that require expertise in requiring clinical, coding, charge capture, and billing. The position serves as the key liaison for all revenue integrity efforts as it relates to area of responsibilities pertaining to the appropriate assigned financial class. The Charge Review Coordinator supports the Revenue Integrity department by overseeing charge review workflows, coordinating team activities, resolving complex charge-related issues, and serving as a subject-matter expert in charge capture, payer requirements, Epic reporting, and chargemaster utilization. This role ensures accuracy, compliance, and timely resolution of charge-related issues while supporting team performance, training, process improvement, and regulatory alignment.

Requirements

5+ years of experience in revenue integrity, revenue cycle management, healthcare finance, or a related field.
Strong knowledge of Chargemaster (CDM) management, including charge capture processes, coding (CPT, HCPCS, ICD-10), and compliance with CMS and third-party payer requirements.
3+ years of Epic experience, particularly in managing work queues and charge capture functions.
An associate’s degree in healthcare administration, health information management, or a related field is required.
Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500.
Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10.
Extensive knowledge of NCCI edits, and Medicare LCD/NCDs.
Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care.
Extensive working knowledge of health care compliance.
Extensive understanding of medical terminology, anatomy and physiology along with clinic department activities.
Capacity to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with facilitating to all member entities.
Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing personnel.
Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level.
Excellent communication, presentation, organizational, analytical and problem-solving skills.
Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team-based environment.
Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Nice To Haves

Bachelor's degree in healthcare
Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN, or AAPC (COC, CPC) or Epic Certified

Responsibilities

Oversees audits of clinical departments, guiding and monitoring Revenue Integrity team members in assigned areas. Review findings with departmental leadership, focusing on documentation standards and recommendations for improvement.
Identify target populations for audits through random sampling, focused reviews, and issues identified in collaboration with the Revenue Cycle Director and other site personnel. Rotate and select specific clinical areas for in-depth reviews.
Review medical records to ensure accuracy in coding, billing compliance, and medical necessity. Collaborate with coding and financial departments to identify areas needing documentation improvement.
Analyze charge capture reports to verify that charges are accurately posted according to diagnosis and procedure codes, and ensure revenue is routed to the appropriate department or cost center.
Identify charge trends, conduct focused reviews of specific departments, and present findings and recommendations for improvement.
Respond to requested charge audits, offering next-step recommendations and improvements.
Conduct ancillary service quality reviews and departmental audits. Meet with the Facility Revenue Cycle Director and departmental managers to improve charge capture accuracy.
Offer feedback to providers regarding missing, incomplete, or unclear documentation, and recommend solutions to improve accuracy and compliance.
Provide guidance on charge capture, coding, documentation, and regulatory compliance as requested.
Conduct training and orientation in group and one-on-one settings, and lead in-service presentations for nursing, physician, and clerical staff to address audit findings and regulatory updates.
Work with Charge Review Analysts and Specialists to ensure accurate and timely responses to departmental inquiries. Collaborate with Denials/Appeals and Coding teams to drive results through the revenue cycle.
Stay current on Charge Description Master (CDM), clinical charging procedures, and related systems to ensure accurate billing and claims processing.
Maintain up-to-date knowledge of Medicare/Medicaid billing practices and apply CMS rules, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and other regulatory guidelines to ensure compliance.
Contribute to the development of policies, standard operating procedures, and knowledge documents aimed at improving processes, strengthening controls, and enhancing revenue.
Actively participate in team development, working toward achieving department dashboards, goals, and objectives.
Regularly review industry literature and attend coding conferences to stay informed of changes in coding standards and quality assurance methodologies.
Perform additional responsibilities as assigned to support the overall success of the Revenue Integrity Team.