ED Charge Specialist

DCH Health Care Authority•Tuscaloosa, AL

1d•Onsite

About The Position

Under the supervision of the Emergency Department Director, the ED Charge Specialist assists in planning and ensuring correct processes and procedures related to ED / Facility charge capture. This role involves assigning appropriate Emergency Department (ED) E/M levels, procedures, injections/infusions, and administration facility charges for hospital services using the facility's tools and programs for charge capture. The specialist also assigns appropriate modifiers with ICD-10, CPT, and HCPCS Level codes as required. A key aspect of the role is maintaining a working knowledge of clinical/business processes and data flow to optimize both, ensuring productivity standards are met, and ED charges are current or entered within 72 hours of patient discharge. The specialist is responsible for timely and accurate charge corrections, effective communication with coding colleagues, and active participation in ED and Coding education teams. The role also involves maintaining statistics/logs, identifying all chargeable ED services and supplies, calculating ED Evaluation and Management (E&M) levels, and identifying infusion, injection, and transfusion charges per CPT hierarchy guidelines for ED and outpatient/bedded outpatient services. The specialist must enter charges, quantities, and modifiers within 72 hours of patient discharge, maintaining a greater than 97% completion rate. They identify and notify originators of documentation deficiencies affecting billing to promote proactive improvements in charge capture. Collaboration with other departments on routine and special project analysis is crucial to ensure accuracy and completeness of charges for insurance and patient billing of inpatient and outpatient hospital services. The specialist also assists with special projects related to charge capture and rebill projects, collaborates with other departments on charge capture/documentation issues, and helps develop educational opportunities. They serve as a communication link between clinical/billing personnel and other reimbursement specialists, discussing issues, recommendations, solutions, and answering questions related to patient charges, auditing, and charge master. The role also includes performing other duties as assigned, adhering to DCH Standards for performance, patient and employee satisfaction, financial standards, compliance requirements, and DCH Behavioral Standards. Essential job functions must be performed safely, identifying and reducing risks. The role requires the use of electronic mail, time and attendance software, learning management software, and intranet, and adherence to all DCH Health System policies and procedures.

Requirements

High school diploma or GED required.
Working knowledge of Microsoft Office products required.
Understanding the composition of a medical record, and the ability to read and interpret is essential.
Displays problem solving ability, initiative, reasoning ability, decision making techniques, is detailed oriented, and appropriate use of resources.
Demonstrated ability to interact professionally on the phone and in person with staff, doctors, and supporting departments.
Must be able to read, write legibly, speak, and comprehend English.

Nice To Haves

Minimum two (2) years hospital, medical billing experience.
Coding Licensure or other certifications.
Degree in medical insurance billing and coding.
Working knowledge of medical terminology, anatomy, physiology, medications, and CPT/HCPCS.
Charge entry/capture experience, working knowledge of hospital policies and procedures, and experience with hospital EMR.

Responsibilities

Assigns the appropriate Emergency Department (ED) E/M level, procedures, injections/ infusions and administration facility charges for hospital services using the facilities tools and programs for charge capture.
Assigns appropriate modifiers with ICD-10, CPT and HCPCS Level codes as required.
Maintain a working knowledge of clinical/business processes and data flow to ensure that both are optimized.
Maintain productivity standards and ensure ED charge remains current or entered within 72 hours of patient discharge.
Ensure charge corrections are completed timely and accurately.
Communicate effectively with coding colleagues with positive outcome of charging questions.
Actively participate in ED and Coding education teams.
Maintain statistics / logs as required.
Identify all chargeable ED services and Supplies
Calculate ED Evaluation and Management (E&M) level
Identify infusion, injection, and transfusion charges per existing Current Procedural Terminology (CPT) hierarchy guidelines for ED and outpatient/bedded outpatient services.
Enter charges, quantities, and modifiers, when indicated, within 72 hours of the patient’s discharge.
Maintains greater than 97% completion rate of charges in less than 72 hours
Identify deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related charge capture.
Collaborate with other departments on routine and special project analysis to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services.
Assist special projects related to charge capture and rebill projects.
Collaborate and assist other departments to address charge capture/documentation issues and assist with the development of educational opportunities.
Serve as a communication link between clinical/billing personnel and other reimbursement specialists in discussing issues, recommendations, solutions, and answering questions related to patient charges, auditing, and charge master.
Perform other duties as assigned.
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
Performs compliance requirements as outlined in the Employee Handbook
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Requires use of electronic mail, time and attendance software, learning management software and intranet.
Must adhere to all DCH Health System policies and procedures.
All other duties as assigned.