Charge Entry Specialist - Revenue Cycle

POSITION SUMMARY:

Responsible for daily review of Observation status orders, calculation of observation hours and entering appropriate charges based on CMC policy and state and federal guidelines. Responsible for daily review of Infusion reports from all hospital nursing units. Responsible for entering appropriate charges for Infusion charges based on the charge capture tool and coding guidelines. Responsible for using approved coding standards, accurate charging for all billable infusion services and to ensure charges are supported by documentation. Track status of all charts submitted for infusion and observation services.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Under the direct supervision of the Director of Revenue Cycle, and within established Catholic Medical Center department policies and procedures, the incumbent performs the following functions:

1. Obtain all appropriate charge forms and reports for infusion therapy (IV infusions/Piggybacks, IV push and Hydration) from the nursing units and EMR.

2. Perform quality assurance on charge forms to ensure accuracy and completeness in conjunction with CPT guidelines and the Charge Master files.

3. Contact appropriate staff members as needed to obtain missing information or clarification on information prior to charge entry.

4. Enters IV charges as soon as possible after the date of service and accurately, ensuring all charges received are input timely into the billing system.

5. Enters charges in appropriate sequence to ensure maximum reimbursement from payers.

6. Observation charges will be calculated and entered based on CMC Observation Charge Capture Policy.

7. Participate in formulation/updates of Charge Capture policies/procedures as needed.

8. Provide education to staff regarding appropriate documentation as needed for IV charge capture.

9. Obtain Observation status accounts from units/case management.

10. Calculate observation hours inclusive of Carve Out times and enter appropriate charge into the billing system on or within 3 days after discharge.

11. Consult with Case Management as needed to clarify patient status and hours.

12. Maintain a working knowledge of applicable Federal, State, and Local laws and regulations including the Standards of Conduct, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behaviors.

13. Support and conduct one's self in a manner consistent with customer service expectations.

14. Utilizes application software for maximum efficiency and communicates suggestions for improvement.

15. Maintain open communication with Nursing, Health Information Management, Case Management and Finance Departments.

16. Maintain minimum productivity standard of 20 IV records per hour inclusive of charge review with 95% accuracy rating based on audits.

17. Maintain 95% accuracy in Observation Charging hours based on audits with completion of all charge entry within 3 days of patient discharge.

Education:

High school diploma or equivalent

Education in a medically related discipline or equivalent work experience with knowledge of medical terminology, anatomy/physiology, familiarity with medications, abbreviations, emergency procedures, charges for procedures are beneficial.

Education as a Medical Coder is not necessary but also beneficial.

Experience:

Experience, preferably working in a health care setting performing similar work activities including, but not limited to charge entry, coding, or billing processes.

Knowledge of ICD10, CPT, HCPCS and reimbursement rules for medical necessity, claims denial, bundling issues and charge capture.

Licensure /Certification:

None