Charge Review Specialist

JOB SUMMARY: Reviews all encounters in CPS Charge review for correct CPT level of service, ICD-10CM coding, and documentation requirements. Ability to identify coding trends, and provide feedback to CDI Team and providers.

EDUCATIONAL REQUIREMENTS:

• High school diploma required
• College education or trade school preferred
• Certified Professional Coding certification preferred

QUALIFICATIONS AND SKILLS:

• Minimum 1 year experience working in a physician group practice billing department
• Working knowledge of CPT and ICD10-CM coding for orthopaedic surgery
• Comfortable using email and interacting with Internet applications
• Knowledge of practice management and word processing software
• Able to establish good relationships with insurance companies
• Good analytical skills and an affinity for detail
• Ability to read and analyze accounts receivable and payor reports
• Pleasant speaking voice and demeanor
• Neat, professional appearance
• Strong written and verbal communication skills

Essential responsibilities include, but are not limited to:

Charge Review work queue

• Accurately reviews all encounters in the office setting for coding and documentation requirements, based on CPT guidelines. Substantiates medical necessity for all encounters.
• Appends CPT modifiers appropriately. Follows Hosted Claims Manager coding edits, and recommends updates to HCM accordingly. Follows NCCI guidelines for bundling of services.
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Reconciles that all charges have been captured on a monthly basis. Reaches out to providers to verify and validate information, as well as providing real time coding education.
• Acts as a practice resource for CPT and ICD10 CM coding guidelines. Responds to written and telephone inquiries from other OSG departments.
• Identifies areas of redundancy or deficiency within the Charge Review work flow
• Meets with Charge Review and a member of the Accounts Receivable Team monthly to discuss coding, reimbursement, and work flow issues.

Other

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
• Attends regular staff meetings as requested
• Attends AAPC, AAOS continuing education sessions on an ongoing basis
• Performs any additional duties as required by the Billing Department

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Work may require sitting for long periods of time, and also stooping, bending and stretching for files and supplies. Employee will occasionally be asked to lift files or paper weighing up to 30 pounds. Position requires manual dexterity sufficient to operate a keyboard, operate a computer, telephone, copier, and such other office equipment as necessary. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. Position also requires viewing computer screens and typing for long periods of time, and working in an environment which can be very stressful.