Charge Entry Specialist I/II

POSITION SUMMARY:

The incumbent performs highly technical and specialized functions by reviewing, analyzing, and charging procedures performed in the clinic setting.  The primary function of this position is to select the appropriate charge codes based on the procedure(s) performed.  The charging function is a primary source for data and information used in health care reimbursement, and promotes provider/patient continuity, and accurate database information. The charging function(s) ensures compliance with established charging guidelines, third party reimbursement policies, regulations and accreditation guidelines. This position is eligible for teleworking with supervisor approval and upon a successful training/trial period. Teleworker must have a reliable and adequate internet connection with a minimum 20Mbps internet speed. Teleworker using personal virtual desktop must use on VMware Horizon 7 to conduct their work off-site. Teleworkers are responsible for complying with all applicable TCRHCC policies (Telework Policy and Procedures, Remote Access, and the Telework Agreement).

NECESSARY QUALIFICATIONS:

Education:

High School Diploma or GED

     Experience:

            Charge Entry Specialist I

• Three (3) months experience with medical coding or charging

     Charge Entry Specialist II

• Two (2) years of medical charging experience

Certification:

            Charge Entry Specialist II:

• Certificate in medical coding

MENTAL AND PHYSICAL EFFORT

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

Physical:

The work is primarily sedentary with the following physical requirements; prolonged ability to sit; frequent ability to twist and reach. Occasional ability to stand, walk, drive, bend, climb, kneel, crouch and maintain balance.  Must have ability to  pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, calculator, printer, fax, etc. This position requires the prolonged use of keyboards utilizing repetitive movement of fingers. Incumbent must  be able to utilize hands occasionally in simple grasping, firm grasping, and fine manipulation. Must be able to utilize a keyboard for a prolonged period with repetitive movement of fingers. Position requires the sensory requirements prolonged ability for near vision, color vision, depth perception, seeing fine details, hearing normal speech. The work requires frequent ability to hear overhead pages over a loudspeaker and telephone use. Occasionally the incumbent may need to be able to have far vision.

Mental:

Exercise a high degree of judgment and leadership in planning, organizing, staffing, directing, evaluating and business office activities.  Work is reviewed for conformance to policies, procedures, and practices relating to business offices practices. The employee must have the ability to organize, set priorities, develop, and implement solutions, motivate employees, and operate the department according to the constraints of The Joint Commission, budget, and regulatory agencies. Ability to interact between all disciplines within the facility is required. Must be able to occasionally, make decisions under high pressure, cope with anger/fear/hostility of others in a calm way; manage altercations; handle multiple priorities in stressful situations; adapt to shift work and work in areas that are close and crowed. Incumbent must have prolonged ability to concentrate; handle a high degree of flexibility; work alone and demonstrate high degree of patience.  Must be able to accept flexible schedule to meet unit needs.

       Environmental:

Employee will occasionally be exposed to infectious disease, chemical agents, dust, fumes, gases, extremes in temperature or humidity, hazardous or moving equipment, unprotected heights, and loud noises.

ESSENTIAL FUNCTIONS:

Charging Specialist I

• Relies on instruction and pre-established guidelines to perform the functions of the job
• Work under immediate supervision or team lead leader

Charging Specialist II

• Relies on limited experience and judgment to plan and accomplish goals and performs a variety of tasks
• Works under general supervision with a certain degree of creativity and latitude

1. Receives and reviews charge documents from the Emergency Department, clinics or inpatient services.
2. Abstracts all necessary information and assigns charge codes, which most accurately describe each documented note, surgical procedure and special therapy or procedure according to established guidelines.
3. Ensures charge information provided is correct and accurate. Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct medical code.
4. Supports charge description master maintenance efforts and initiatives.
5. Coordinates revenue enhancement opportunities for all entities supported by the Revenue Integrity Department leadership.
6. Balances Charge Summary to Charge Order Sets or Superbills before updating charges.
7. Keeps supervisor or Lead apprised of matters regarding charge entry including errors and escalations
8. Enters charges in a timely manner in a high-volume setting. Minimum expectation is to complete charging for 120 ambulatory visits per day.  Inpatient charging is expected to be within one day of service.
9. Analyzes, Evaluates, and Reports, Reviews and follows-up on daily reports to identify accounts that have potential lost, over, undocumented, and or duplicate charges.
10. Works with 3rd party vendor identifying missed charges, work queue as assigned and rebill accounts accordingly.
11. Reviews and follows-up on daily reports to identify late charges.
12. Researches, identifies, prioritizes, and communicates charge integrity opportunities.
13. Contributes to Revenue Risks and Opportunities management and tracking efforts.
14. Contributes strategic pricing processes to include annual and periodic pricing updates, CPT/HCPC updates and reporting, fee schedule queries, and procedure queries.
15. Works collaboratively across disciplines and communicates with various customers while seeking solutions.
16. Prioritizes and attends ad-hoc meetings as needed to provide support in areas of expertise.
17. Maintains expertise in the patient account system and Charge Description Master (CDM).
18. Follows-up with clinical, coding, billing and operational contacts to resolve revenue integrity concerns in a timely manner.
19. Works with revenue integrity, finance and clinical leadership to develop, implement charge capture entry, validation, reconciliation and correction processes; developing and implementing protocols, policies and procedures to support charge capture accuracy and timeliness.
20. Keeps current with trends, developments in the profession, industry and related fields of expertise.
21. Must have an understanding of Revenue Cycle concepts and knowledge of clinical concepts.