JOB DESCRIPTION:

Shift: First Shift,Mon,Tue,Wed,Thu,Fri

SUMMARY

The Charge Capture Specialist is responsible for reviewing charges, coding, and documentation to ensure compliance with payer requirements, optimizing revenue, and minimizing billing errors. This position collaborates with clinical, billing, and coding teams to resolve discrepancies and identify opportunities for charge capture improvement.

MINIMUM JOB REQUIREMENTS:

• The minimum age requirement for this position is 18 years old.
• High School Diploma or equivalent.
• Two (2) years of experience in healthcare Revenue cycle processes, professional or hospital charging, claims billing, coding, Charge Master, audit, accounts payable/receivable, compliance or related experience.
• Advanced knowledge of revenue cycle processes and medical billing to include CDM, UB, RAs and 1500.
• Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
• Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
• Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
• Excellent interpersonal and communication skills.
• Demonstrates excellent interpersonal skills and the ability to interact effectively with a variety of individuals and groups.
• Excellent organizational and communication skills.
• Working knowledge of Federal and State regulatory requirements and accreditation standards, including NCQA, CMS.
• Exercise sound judgement and an ability to remain professional in all situations.
• Demonstrates the ability to work independently and make sound independent judgment and have strong decision-making abilities.
• Requires in-depth research and analysis, with a strong working knowledge of CPT codes.
• This is a safety-sensitive position and will be subject to pre-employment drug testing and criminal history background check, which will include fingerprinting.
• Must have employment eligibility in the U.S.
• Indian preference will be observed in the hiring process.
  From: Three Rivers Casino Resort/CTCLUS

• Ensures accurate and timely charge capture processes for assigned service lines, maintaining standardization across relevant areas.
• Reconciles charges with source documents to ensure completeness and accuracy, while monitoring compliance with internal procedures and reporting issues of non-compliance.
• Reviews patient records and medical documentation to verify that all services are captured and documented in compliance with healthcare regulations and payer requirements.
• Identifies billing errors or omissions and collaborates with relevant teams to correct and revise them promptly.
• Works closely with physicians, clinicians, and other healthcare staff to clarify discrepancies or missing information related to charge documentation.
• Trains staff involved in billing data entry and charge reconciliation to ensure procedures are understood and charges are accurate, timely, complete, and well-documented.
• Prepares reports and provides summary information to the Revenue Cycle team to ensure system-wide charge capture, proper billing, reimbursement, and compliance.
• Provides expertise to implement process improvements and system updates to prevent charge errors and omissions, while assisting in the maintenance of clinical charging systems.
• Maintains an up-to-date understanding of industry standards, payer policies, and coding changes to ensure compliance and accuracy.
• Ensures adherence to all privacy regulations, including HIPAA, when handling patient data and documentation.
• Other duties as assigned by management.