Charge Review Specialist II - Remote - Certified Coder Preferred

JOB SUMMARY 

This job is responsible for ensuring that all appropriate billing charges for complex service lines are being captured, documented, charged and reimbursed for the assigned department in accordance with policies and procedures, and applicable regulatory standards and requirements.  Position requires a working knowledge of CPT codes. Focuses on work unit and/or service-line; specifically, Diagnostic Imaging (ie. Radiology), Interventional Radiology, and Cath Lab reconciliation processes.  Certified Coder preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Ensures accurate and timely charge-capture methodologies are in place and followed for the assigned work unit or service line, and that they are consistent (in terms of standardization) across pertinent areas/facilities as appropriate; reconciles charges against source documents to ensure that charges have been captured completely and accurately; monitors compliance with internal standards and procedures, and reports non-compliance issues to proper authority.
• Identifies billing errors and/or omissions, working with appropriate staff/team members; ensures that revisions/corrections forwarded and incorporated in processing systems in timely manner.   In-depth research and analysis may be required. Strong working knowledge of CPT codes are essential.
• Provides training to staff engaged in billing data entry and related charge-capture/reconciliation activities to ensure procedures are understood and that charges booked are timely, appropriate, accurate, complete and properly documented.
• Prepares reports, and provides departmental summary information to the Revenue Cycle team which is responsible for ensuring that all charges on a system-wide basis are being captured, charged and reimbursed appropriately and for overall compliance.
• Maintain proficiency in potentially including subject matter including injection & infusion CPT Coding/charging, Observation, & abstracting of inpatient record to identify procedures performed.
• Provide subject matter expertise to implement changes & system improvements that prevent charging errors and omissions as wells as collaborating in the upkeep & maintenance of clinical charging systems.  
• Other Duties as assigned including edit/holds, coordination with CDM team/system, client & peer education

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement. 
• Knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance.
• Knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines.
• Ability to recognize, research, and correct charging/documentation discrepancies.
• Knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues.
• Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
• Ability to establish and maintain effective working relationships as required by the duties of the position.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• At least 3 years recent directly related work experience in a healthcare environment with significant exposure to healthcare charging/coding or completion of a recognized course of study for health information practitioners or coding specialists and one year coding experience in an acute hospital health information management department  
• Proficient in CPT/HCPCS code assignment including Evaluation &