The Charge Review Specialist serves as the primary reviewer of all related charges in the electronic health record (EHR) and/or other clinical applications. The position coordinates and completes line-item charge review of patient encounters in VCUHS charge systems to ensure the accuracy and completeness of charges captured for insurance and patient billing of hospital services. Using electronic platforms, the position reviews all charges, both inpatient and outpatient, that are incurred on “flagged” accounts daily to ensure that they meet proper classification and payer account eligibility requirements, determines charges/bills that are eligible for release, and directs charges to the appropriate client account for all payers. The position provides specialized support to clinical, business, IT, and revenue cycle personnel regarding billing.

Essential Job functions:

• Utilizes electronic database management systems in the management of charge postings, providing oversight of technical and professional charges generated from ancillary subsystems to verify the accuracy of charges as they compare to the research billing intention/plan.
• Coordinates and completes review of all charges that are incurred on “flagged” accounts daily to ensure that they meet proper classification and payer account eligibility requirements.
• Determines destination account for inpatient, outpatient and physician groupings and directs appropriate evaluated charges to the client account.
• Verifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections/reimbursements/adjustments as identified.
• Under direction of management, collects data regarding charges and prepares reports and develops deliverables summarizing the accuracy of the system.
• Continuously audits electronic charge platform for accuracy and compliance.
• Works with members of organization-wide finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.
• Analyzes output to determine whether appropriate action was taken and make or request corrective action as required, in accordance with regulatory and institutional policies.
• Collaborates with the department’s clinical and business colleagues in the development and implementation of educational activities related to charge capture improvement projects.
• Maintains operational, GCP, and regulatory compliance at all times, utilizing comprehension of regulations as determined by CMS, CFR, and federal, state, and institutional regulations.
• Generates and monitors budgeting scenarios and continuously evaluates the coding and budgeting process for improvements to support the implementation of action and/or contingency planning.
• Follows patient privacy regulations, maintaining confidentiality in all practice.

Patient Population:
• Not applicable for this position

Employment Qualifications:

Required Education:
• High School Diploma or Equivalent

Preferred Education:
• Bachelor's degree in Finance, Accounting, Business/Health Administration or a related field from an accredited program or Bachelor’s Degree in Nursing

Licensure/Certification Required:
• N/A

Licensure/Certification Preferred:
One of the following Certifications is Preferred:
• Certified Professional Coder (CPC) or
• Certified Outpatient Coder (COC), formerly CPC-H or,
• Certified Inpatient Coder (CIC) by the American Academy of Procedural Coders or,
• Certified Coding Specialist (CCS), or
• Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA)

Minimum Qualifications:

Required Qualifications:
• Minimum of two (2) years of work experience in medical billing; and
• Minimum of three (3) years of work experience in a customer-related service position;
• Working knowledge of medical terminology and medical procedures;
• Previous experience using a personal computer and various software applications, including Microsoft Office Word and Excel, e-mail, etc.
• Detail-oriented and self-motivated team player
• Ability to manage daily work is independently
• Ability to seek direction, advice, guidance from from management, Clinicians and other applicable resources as necessary.
• Ability to meet deadlines in ever changing work environment.

Preferred Qualifications:
• Previous experience with protocols and/or financial/budgeting for clinical trials;
• Previous patient records review and abstraction experience;
• Previous experience in medical coding; and
• Three (3) years of work experience in a team environment.

Cultural Responsiveness:
Demonstrates a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias

Working Conditions:
Periods of high stress and fluctuating workloads may occur.
General office environment.

Physical Requirements:

Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards:

Physical Requirements: Repetitive arm/hand movements, finger dexterity, Acuity - near

Hazards: None

Mental/Sensory - Emotional:

Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical Thinking
Emotional: Fast pace environment

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.