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Under the direction of the Manager of Revenue Integrity, the Charge Integrity Specialist is responsible for reviewing and validating patient charges before billing to ensure accuracy and compliance with coding and billing regulations. The role involves working collaboratively to resolve discrepancies and improve the overall charge capture process by identifying trends and themes. The Charge Review Specialist ensures that all charges are accurately reflected in patient accounts and that any issues are promptly addressed. The position receives general oversight by the Charge Review Coordinator.
GENERAL DUTIES:
- Review patient charges to validate they are accurately entered and supported by clinical documentation.
- Ensure charges match the procedures and services provided, using appropriate charge capture standards.
- Assist in daily resolution of revenue integrity edits that prevent accounts from billing, by reviewing the medical record and applicable documentation.
- Expected to identify and investigate discrepancies or missing charges in patient accounts with the intent to resolve. Report issues and participate in the resolution of any potential or actual revenue/charge related issues.
- Coordinate Charge Description Master (CDM) error findings with CDM team.
- Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards.
- Responds to departmental charging inquiries in a timely manner and document questions received to create repository.
- Provide support for assigned cost centers within service lines in collaboration with the charge integrity teammates.
- Works with Coding and other clinical departments to identify and resolve errors based on ICD/CPT Coding Guidelines and National Correct Coding Initiative edits.
- Contributes and supports quarterly improvement initiatives as directed by revenue integrity leadership.
- Serve as primary service line representative for all charge related inquiries and issues and proper usage of charge codes.
- Offers feedback on issues identified, and potential solutions, in the spirit of process improvement.
- Monitor and report charge capture trends and provide input on improvements that prevent revenue leakage.
- Perform quality work within deadlines and/or Key Performance Indicators (KPIs) with or without direct supervision.
- Interacts professionally with coworkers and customers.
- Work effectively as a team contributor on all assignments.
- Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
- Delivers positive patient experience, where applicable
- Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
- Performs other miscellaneous duties as assigned.
EXPERIENCE QUALIFICATIONS:
- Required: 2 years' experience in a hospital setting, revenue cycle, healthcare industry or coding.
- Preferred: EPIC HB/PB experience
EDUCATION QUALIFICATIONS:
- Minimum: High school diploma or GED with equivalent combination of certification and experience is required.
- Preferred: Associate’s degree in healthcare administration, Health Information or related field
LICENSES AND CERTIFICATIONS:
- Certification: Applicable professional certification through AHIMA (CCA) or AAPC (CPC‑A, COC-A) are highly desirable. Must obtain professional credential within 6 months of employment or Epic Certified.
SKILLS AND ABILITIES:
- Due to its service focus, this position requires interpersonal and communication skills, analytic and organizational skills, critical –thinking and the ability to meet deadlines.
- Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
WORK SHIFT:
Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary
Your extras
- Deliver healthcare with heart.
- Give people a reason to smile.
- Put a little love in your work.
- Be honest and real, but with compassion.
- Bring some lagniappe into everything you do.
- Forget one-size-fits-all, think one-of-a-kind care.
- See opportunities, not problems – it’s all about perspective.
- Cheerlead ideas, differences, and each other.
- Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
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