CommUnityCare Health Centers
Job Summary
Charge Review Specialist Senior role at CommUnityCare Health Centers. The Charge Review Specialist Senior works a part of a centralized Revenue Cycle team to process accurate code assignments for paper and/or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding/edit reviews. Ensures all professional aspects of the assignment of diagnostic and procedural coding are carried out in compliance with applicable Medicare, Medicaid and third‑party payer guidelines. Reviews provider patient charting to ensure accuracy as well as adherence to correct coding initiative guidelines. Adheres to internal coding policies and expectations set forth by leadership. Essential Duties
Ensure timely and accurate processing of claims in a manner that is consistent with company processes and procedures and industry best practices through direct efforts and coordination of other efforts. Under the direction of the Revenue Integrity Manager, determine correct sequence of ICD 10, CPT and HCPCS codes. Answer coding questions from providers and staff, assisting in definition and guidance of all applicable regulatory standards and correct coding initiatives. Analyze and evaluate provider coding to ensure standards are adhered to and provide guidance to providers as needed. Maintain strict confidentiality; comply with all HIPAA guidelines/regulations and company policy for all compliance areas. Meet daily productivity goals. Actively participate as a member of the Revenue Cycle Team, assisting others as needed to ensure all daily activities are completed, company goals achieved, and continuous improvements and cost efficiencies are pursued. Develop, implement, and consistently seek improvement in policies and procedures for all charge review to ensure department activities are carried out professionally and ethically, patients are treated respectfully, and revenue is optimized. Review documentation for appropriateness based on coding submitted by providers. Audit claims processed by Charge Review Specialists for quality assurance and guideline adherence. Initiate and respond to telephone inquiries from providers, clients and patients. Document all communication and activities in billing notes to assist with clear, concise and accurate communication to all who work with patient billing ledgers and processes. Demonstrate a willingness to be an active participant in initiatives that have fundamental impact on the organization. Perform any other duties as needed to drive the vision, fulfill the mission, and abide by the values of this organization. Knowledge / Skills / Abilities
Thorough knowledge of billing and coding policies and procedures. Knowledge of ICD 10, CPT, HCPCS and modifiers for all provider coding and billing assignments. Provide service of the highest quality in a professional and courteous manner to referral sources and patients. Proficiency in filing and collecting insurance claims. Analytical skills to examine billing information for accuracy and completeness. Previous experience with electronic claim filing and practice management software packages. Computer literate in current Windows applications – Word, Excel, PowerPoint and Outlook. Typing and 10‑key proficiency; perform computer and data entry functions. Assess and revise processes based on data analytics and evolving information. Knowledge of healthcare billing and reimbursement procedures and regulations. Basic accounting skills; audit patient accounts accurately. Organize and prioritize workload, coordinate many assignments simultaneously and meet deadlines. Be well organized and detail oriented. Work independently and proactively engage supervisor and coworkers when needed. Build relationships and provide excellent customer service. Utilize computers for data entry, research and information retrieval. Excellent verbal and written communication skills. Strong work ethic and high level of professionalism. Analytical and problem‑solving skills; use data to identify patterns and trends. Demonstrated knowledge of medical terminology, anatomy and insurance processes. Proficiency in use of computer and commonly used software, including Microsoft Office suite. Experience with EPIC PM/EMR system is preferred but not required. Minimum Education
High school diploma or GED. Minimum Experience
4 years of relevant healthcare revenue or medical billing cycle experience, which includes coding. Preferred Experience
4 years of experience working with FQHC billing and revenue cycle activities. Required Certifications / Licensure
Certified Coding Specialist (CCS) through governing body AHIMA Certified Coding Specialist – Physician (CCS‑P) through governing body AHIMA Certified Professional Coder (CPC) through governing body AAPC Certified Professional Coder – Hospital (CPC‑H) through governing body AAPC Employment Type
Full‑time. Seniority Level
Mid‑Senior level.
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Charge Review Specialist Senior role at CommUnityCare Health Centers. The Charge Review Specialist Senior works a part of a centralized Revenue Cycle team to process accurate code assignments for paper and/or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding/edit reviews. Ensures all professional aspects of the assignment of diagnostic and procedural coding are carried out in compliance with applicable Medicare, Medicaid and third‑party payer guidelines. Reviews provider patient charting to ensure accuracy as well as adherence to correct coding initiative guidelines. Adheres to internal coding policies and expectations set forth by leadership. Essential Duties
Ensure timely and accurate processing of claims in a manner that is consistent with company processes and procedures and industry best practices through direct efforts and coordination of other efforts. Under the direction of the Revenue Integrity Manager, determine correct sequence of ICD 10, CPT and HCPCS codes. Answer coding questions from providers and staff, assisting in definition and guidance of all applicable regulatory standards and correct coding initiatives. Analyze and evaluate provider coding to ensure standards are adhered to and provide guidance to providers as needed. Maintain strict confidentiality; comply with all HIPAA guidelines/regulations and company policy for all compliance areas. Meet daily productivity goals. Actively participate as a member of the Revenue Cycle Team, assisting others as needed to ensure all daily activities are completed, company goals achieved, and continuous improvements and cost efficiencies are pursued. Develop, implement, and consistently seek improvement in policies and procedures for all charge review to ensure department activities are carried out professionally and ethically, patients are treated respectfully, and revenue is optimized. Review documentation for appropriateness based on coding submitted by providers. Audit claims processed by Charge Review Specialists for quality assurance and guideline adherence. Initiate and respond to telephone inquiries from providers, clients and patients. Document all communication and activities in billing notes to assist with clear, concise and accurate communication to all who work with patient billing ledgers and processes. Demonstrate a willingness to be an active participant in initiatives that have fundamental impact on the organization. Perform any other duties as needed to drive the vision, fulfill the mission, and abide by the values of this organization. Knowledge / Skills / Abilities
Thorough knowledge of billing and coding policies and procedures. Knowledge of ICD 10, CPT, HCPCS and modifiers for all provider coding and billing assignments. Provide service of the highest quality in a professional and courteous manner to referral sources and patients. Proficiency in filing and collecting insurance claims. Analytical skills to examine billing information for accuracy and completeness. Previous experience with electronic claim filing and practice management software packages. Computer literate in current Windows applications – Word, Excel, PowerPoint and Outlook. Typing and 10‑key proficiency; perform computer and data entry functions. Assess and revise processes based on data analytics and evolving information. Knowledge of healthcare billing and reimbursement procedures and regulations. Basic accounting skills; audit patient accounts accurately. Organize and prioritize workload, coordinate many assignments simultaneously and meet deadlines. Be well organized and detail oriented. Work independently and proactively engage supervisor and coworkers when needed. Build relationships and provide excellent customer service. Utilize computers for data entry, research and information retrieval. Excellent verbal and written communication skills. Strong work ethic and high level of professionalism. Analytical and problem‑solving skills; use data to identify patterns and trends. Demonstrated knowledge of medical terminology, anatomy and insurance processes. Proficiency in use of computer and commonly used software, including Microsoft Office suite. Experience with EPIC PM/EMR system is preferred but not required. Minimum Education
High school diploma or GED. Minimum Experience
4 years of relevant healthcare revenue or medical billing cycle experience, which includes coding. Preferred Experience
4 years of experience working with FQHC billing and revenue cycle activities. Required Certifications / Licensure
Certified Coding Specialist (CCS) through governing body AHIMA Certified Coding Specialist – Physician (CCS‑P) through governing body AHIMA Certified Professional Coder (CPC) through governing body AAPC Certified Professional Coder – Hospital (CPC‑H) through governing body AAPC Employment Type
Full‑time. Seniority Level
Mid‑Senior level.
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