Charge Review Specialist II - Remote - United States

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 reconciliation processes.  

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 & Management facility coding guidelines
• High School graduate or equivalent required
• College degree preferred.

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Office Work Environment
• Hospital Work Environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

 

Compensation and Benefit Information

Compensation

• Pay: $20.51-$30.77 per hour. Compensation depends on location, qualifications, and experience. 
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

 

No. Description % of Time

1.  

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. 30%

1.  

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. 25%

1.  

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. 10%

1.  

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. 10%

1.  

Maintain proficiency in potentially including subject matter including injection & infusion CPT Coding/charging, Observation, & abstracting of inpatient record to identify procedures performed. 5%

1.  

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.  5%

1.  

Other Duties as assigned including edit/holds, coordination with CDM team/system, client & peer education 5% FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):                                           N/A

 

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 & Management facility coding guidelines
• High School graduate or equivalent required
• College degree preferred.

 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

                            

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

 

 

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

 

• Office Work Environment

Hospital Work Environment

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