Charge Review Specialist Senior (REMOTE)

CommUnityCare Health Centers•Austin, TX

6d•Remote

About The Position

The Charge Review Specialist Senior is part of a centralized Revenue Cycle team and processes accurate code assignments for paper and/or electronic claims, along with required billing data elements, before charges are processed for payment and revenue reporting. This includes coding and edit reviews. The role ensures that diagnostic and procedural coding assignments comply with applicable Medicare, Medicaid, and third-party payer guidelines. It reviews provider patient charting for accuracy and adherence to correct coding initiative guidelines, and follows internal coding policies and leadership expectations.

Requirements

High school diploma or GED.
At least 4 years of relevant healthcare revenue-cycle or medical-billing experience, including coding.
Maintain one of the following certifications: Certified Coding Specialist (CCS) through AHIMA; Certified Coding Specialist–Physician (CCS-P) through AHIMA; Certified Professional Coder (CPC) through AAPC; or Certified Professional Coder–Hospital (CPC-H) through AAPC.
Thorough knowledge of billing and coding policies and procedures.
Knowledge of ICD-10, CPT, HCPCS, and modifiers as applied to provider coding and billing assignments.
Ability to provide professional, courteous, high-quality service to referral sources and patients.
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 literacy in current Windows applications, including Word, Excel, PowerPoint, and Outlook.
Typing and 10-key proficiency, including the ability to perform computer and data-entry functions.
Ability to assess and revise processes based on data analytics and evolving information.
Knowledge of healthcare billing and reimbursement procedures and regulations.
Basic accounting skills and ability to accurately audit patient accounts.
Ability to organize and prioritize workloads, coordinate multiple assignments, and meet deadlines.
Strong organizational skills and attention to detail.
Ability to work independently and proactively engage supervisors and coworkers when needed.
Strong relationship-building and customer-service skills.
Ability to use computers for data entry, research, and information retrieval.
Excellent verbal and written communication skills.
Strong work ethic and high level of professionalism.
Analytical and problem-solving skills, including the ability to use data to identify patterns and trends.
Knowledge of medical terminology, anatomy, and insurance processes.
Proficiency with computers and commonly used software, including Microsoft Office Suite.

Nice To Haves

Four years of experience working with FQHC billing and revenue-cycle activities.
Experience with the EPIC PM/EMR system.

Responsibilities

Process claims accurately and on time in accordance with company procedures and industry best practices, coordinating efforts as needed.
Under the direction of the Revenue Integrity Manager, determine the correct sequence of ICD-10, CPT, and HCPCS codes.
Answer coding questions from providers and staff and provide guidance on applicable regulatory standards and correct coding initiatives.
Analyze and evaluate provider coding for adherence to standards and provide guidance to providers as needed.
Maintain confidentiality and comply with HIPAA guidelines, industry standards, regulations, and company policies and procedures.
Meet daily productivity goals.
Participate as a member of the Revenue Cycle Team, assist with daily activities, support company goals, and identify continuous-improvement and cost-efficiency opportunities.
Develop, implement, and improve charge review policies and procedures to support professional and ethical department operations, respectful patient treatment, and optimized revenue.
Review documentation for appropriateness based on provider-submitted coding.
Audit claims processed by Charge Review Specialists for quality assurance and adherence to guidelines.
Initiate and respond to telephone inquiries from providers, clients, and patients.
Document communications and activities in billing notes to support clear and accurate communication for those working with patient billing ledgers and processes.
Participate in initiatives with a fundamental impact on the organization.
Perform other duties as needed to support the organization's vision, mission, and values.