JOB SUMMARY:

The Charge Capture Specialist II is responsible for reviewing clinical documentation to ensure timely, accurate, and compliant charge capture. He/she works closely with Physician Practices as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges. The Charge Capture Specialist II also collaborates with cross-campus counterpart(s) and Physician Practice to ensure clinical documentation in high risk areas is consistent and complete. The Charge Capture Specialist II collaborates with cross-campus counterpart(s) to ensure consistency in processes in such a manner that each individual can act as a back-up for the other to ensure seamless charge capture in high risk areas when one individual is out. Duties include charge entry, ensuring correctness of coding in Charge Review, providing ongoing education to charging departments and reducing payor coding denials.

REQUIRED MINIMUM EDUCATION:

High school diploma Required or equivalent from an accredited institution Required and Bachelor’s Degree Preferred

REQUIRED MINIMUM EXPERIENCE:

Minimum 2 years collection experience Required or Minimum 2 years experience with physician billing Required

REQUIRED MINIMUM SKILLS:

Ability to perform mathematical calculations Keyboard by touch Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices Basic knowledge of medical terminology Basic experience and knowledge of PC applications Detail-oriented, good organizational skills, and ability to be self-directed Ability to learn quickly and meet continuous timelines Strong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere Demonstrated flexibility to perform other tasks as needed in an active work environment with changing work needs High-level problem solving, analytical, and investigational skills Excellent internal/external customer service skills Excellent communication skills to include oral and written comprehension and expression Ability and willingness to exhibit behaviors consistent with principles of excellent service Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect

Job Functions - Ensure charging/documentation is accurate and complete both department to department and cross-campus - Assess physician and nursing documentation to ensure it supports the charge codes selected including supporting medical necessity - Review the clinical records on an ongoing basis to identify any overcharges, undercharges, or charges that necessitate an additional document to be justified - Analyze, verify, and work with departments to modify charging/documentation procedures for high risk areas such as infusion services - Develop and implement training required to educate Physician Practices on the changes, updates, and additions to charge review. - Proactively identify and analyze new charging opportunities in coordination with assigned departments - Research and analyze charge and coding requirements for new services and technologies - Consistently meet the current productivity standards in ensuring accurate charge capture - Consistently meet the current quality standards in ensuring accurate charge capture in high risk areas in a timely manner - Meet productivity standards, benchmarks, targets, and reporting requirements as assigned by the department Manager or Supervisor Management – Professional Development - Provide individual contribution to the overall team effort of achieving the department AR goal - Identify opportunities for system and process improvement and submit to management - Demonstrate proficient use of systems and execution of processes in all areas of responsibilities - Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices - Follow the health system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures - Become cross-trained and fill in for other staff as assigned Administrative – Professional Communication - Assure patient privacy and confidentiality as appropriate or required - Ensure minors have a parent or guardian listed as guarantor as appropriate - Communicate in a professional manner with patients, their families and representatives from third party payor organizations - Communicate in a professional manner with physicians, physician staff, co-workers, management and clinical staff - Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies - Initiate communication with peers about changes and procedures - Relay information appropriately over telephone, email, and other communication devices - Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives Department Methods/Procedures/Operations - Follow department guidelines for lunch, breaks, requesting time off, and shift assignments - Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies - Follow JCAHO and outside regulatory agencies’ mandated rules and procedures - Utilize assigned menus and pathways in the hospital mainframe system. Report software application problems to the appropriate supervisor - Utilize assigned computer hardware. Report hardware problems to the appropriate supervisor - Participate in the testing for assigned software applications, including verification of field integrity - Perform other duties and responsibilities as assigned