Charge Review Specialist Senior (REMOTE)

Central Health•Austin, TX

5d•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. The role includes coding and edit reviews and ensures diagnostic and procedural coding assignments comply with applicable Medicare, Medicaid, third-party payer, and correct coding initiative guidelines. The specialist reviews provider documentation for accuracy and adherence to coding guidelines and follows internal coding policies and leadership expectations. Under the direction of the Revenue Integrity Manager, this role supports accurate and timely claims processing, answers coding questions, provides coding guidance to providers and staff, and audits claims for quality and guideline adherence. The specialist also documents communications and activities, protects confidential information, meets productivity goals, and contributes to the Revenue Cycle team’s daily operations and ongoing process improvement.

Requirements

High school diploma or GED.
At least 4 years of relevant healthcare revenue or medical billing cycle 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.
Knowledge of healthcare billing and reimbursement procedures and regulations.
Ability to file and collect insurance claims and experience with electronic claim filing and practice management software packages.
Analytical skills to examine billing information for accuracy and completeness, audit patient accounts, identify patterns and trends, and solve problems.
Basic accounting skills.
Proficiency with Windows applications and commonly used software, including Microsoft Office applications, and ability to use computers for data entry, research, and information retrieval.
Typing and 10-key proficiency and ability to perform computer and data-entry functions.
Ability to assess and revise processes based on data analytics and evolving information.
Ability to organize and prioritize workloads, coordinate multiple assignments, and meet deadlines.
Strong attention to detail and organizational skills.
Ability to work independently and engage supervisors and coworkers when needed.
Strong relationship-building and customer-service skills, including providing professional and courteous service to referral sources and patients.
Excellent verbal and written communication skills.
Demonstrated knowledge of medical terminology, anatomy, and insurance processes.
Strong work ethic and professionalism.

Nice To Haves

At least 4 years of experience working with FQHC billing and revenue cycle activities.
Experience with the EPIC PM/EMR system.

Responsibilities

Ensure timely and accurate processing of claims in accordance with company procedures and industry best practices.
Determine the correct sequence of ICD-10, CPT, and HCPCS codes under the direction of the Revenue Integrity Manager.
Answer coding questions from providers and staff and provide guidance on regulatory standards and correct coding initiatives.
Analyze provider coding to ensure standards are followed 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 in Revenue Cycle team activities and assist others to complete daily work, achieve company goals, and identify improvements and cost efficiencies.
Develop and improve charge review policies and procedures to support professional and ethical 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 about patient billing ledgers and processes.
Participate in initiatives that have a fundamental impact on the organization.
Perform other duties as needed to support the organization’s vision, mission, and values.