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Charge Management Specialist

2 months ago

Lumberton, North Carolina, United States Southeastern Health Full time
Job Summary

At Southeastern Health, we are seeking a highly skilled Charge Management Analyst to join our team. The successful candidate will be responsible for performing internal quality assessment claim reviews to ensure compliance with federal, payer, and internal Revenue Cycle policies.

Key Responsibilities
  • Conduct thorough reviews of internal quality assessment claims to ensure accuracy and compliance with regulatory requirements.
  • Collaborate with hospital departments to improve the accuracy, integrity, and quality of patient charges.
  • Respond to requests to research and provide resolution for claim data variances.
  • Evaluate payer updates and assist in the performance of audits to ensure timely, accurate, and inclusive charge capture coding and billing functions.
  • Identify charge issues and recommend solutions to improve revenue cycle processes.
Requirements
  • Current coding certification as a RHIA, RHIT, Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or Certified Coding Specialist (CCS) or a minimum of 3 years coding experience.
  • Proficiency with Epic clinical documentation and hospital billing systems.
  • Utilization management, medical review/audits, and denial/appeals experience.
  • Knowledge of Medicare and Medicaid regulations, including billing, coding, and documentation requirements.
  • Knowledge of UB-04 revenue codes, medical billing modifiers, CPT/HCPCS coding, NCCI/OPPS CPT/HCPCS coding edits, Medically Unlikely Edits (MUE), and Medicare advance beneficiary notice (ABN) reporting guidelines.
  • Competent in the use of Electronic Medical Record and Billing Systems.
  • Strong verbal, written, and interpersonal communication skills.
  • Ability to produce accurate, assigned work product within specified time frames.
  • Understanding of multiple reimbursement systems, including IPPS, OPPS, APC, and fee schedules.
  • Proficient in using Microsoft applications, including Outlook, Excel, Word, PowerPoint, and other web-based applications.
  • Ability to research, analyze, and interpret healthcare policies, billing guidelines, and state and federal regulations.