Revenue Charge Specialist, PT, Days

Prisma Health•Greenville, SC

16h•Onsite

About The Position

Ensures complete and accurate revenue integrity charging standards for Perioperative Services for inpatient and outpatient surgery centers. Follows compliant charge capture and billing practices in accordance with Medicare, Medicaid, and third-party payer guidelines. This is a non-management position reporting to a supervisor, director, or executive. The role is based at Greenville Memorial Hospital in Nursing Administration and works the day shift.

Requirements

High school diploma or equivalent, or post-high-school diploma/highest degree earned.
Three years of healthcare revenue cycle experience.
Knowledge of office equipment such as fax machines and copiers.
Proficient computer skills, including word processing, spreadsheets, and databases.
Data-entry, mathematical, and typing skills.

Nice To Haves

CPC certification is preferred and is to be obtained within two years after hire.
Working knowledge of medical terminology, anatomy, and physiology, obtainable through on-the-job training or college coursework, is preferred.
Familiarity with ICD-9-CM, CPT/HCPCS, and UB-04 codes is preferred.
In lieu of the stated education and/or experience, an accredited coding certification from AAPC, AHIMA, or ACMCS, or five years in a healthcare facility or physician office practice with working knowledge of ICD-9-CM, CPT/HCPCS, UB-04 revenue codes, and/or denials may be considered an equivalent substitution.
In lieu of the stated education and/or experience, five years in Health Information Management with working knowledge of ICD-9-CM and CPT/HCPCS may be considered an equivalent substitution.
Team members employed in this job before July 1, 2020, are grandfathered under prior education and experience requirements; they must be certification eligible and obtain required certification(s) within one year.

Responsibilities

Audit charges daily and enter facility fees for Perioperative Services, including surgery, preoperative, and recovery services, in the Perioperative Information system.
Analyze nursing documentation and encounter forms to identify discrepancies and accurately capture revenue.
Enter or credit implant and supply charges in the OPTIFLEX and Demand bill systems to ensure complete and accurate charge capture.
Audit revenue cycle charge proof reports and Bipas against surgeons’ operative notes and other nursing documentation to ensure timely, complete, and accurate billing within accounts receivable timelines and in compliance with requirements.
Review procedures and documentation to determine appropriate CPT codes and ensure correct facility fees, accessing downstream systems as needed for compliant charge capture and documentation integrity.
Notify nurses of documentation and charge-capture errors for correction or clarification, following department guidelines.
Record clinical charge errors identified through audits in the department access database to support RN Perioperative Business Services in developing staff in-services and individual coaching.
Monitor, research, and respond to periodic Perioperative Services billing problems, including identifying supplies or implants needing item and charge numbers and responding to CCA and Xclaim inquiries.
Follow up on and resolve problems promptly, communicating effectively with coworkers, nurses, and management staff; follow established protocols for late charges.
Assist with the annual review of department policies and procedures and complete additional projects assigned by management.
Perform other duties as assigned.