Responsible for account-level pre-bill charge verification to ensure accurate, complete, and compliant claim construction before final billing. This role focuses on identifying and correcting charge capture issues such as missing CPT/HCPCS codes, incorrect CPT/HCPCS selection, unit/revenue code discrepancies, and documentation-to-charge mismatches.
The specialist partners with clinical departments, coding, billing, and revenue integrity leadership to resolve charge defects and reduce preventable revenue leakage.
Key responsibilities include:
- Performing account-level pre-bill charge integrity reviews for designated populations
- Identifying charge defects and reconciling charges to supporting documentation
- Initiating and tracking charge corrections through established workflows
- Applying hold/release criteria for unresolved high-risk charging issues
- Communicating required corrections to billing, coding, and clinical contacts
- Documenting issue category, root cause, action taken, and final disposition
- Escalating recurring defect patterns to Revenue Integrity leadership
- Supporting onboarding, cross-training, and workflow updates as assigned
Requirements & Qualifications
Education and experience:
- High school diploma or equivalent required
- Associate degree in healthcare, business, nursing, health information, or related field preferred
- 3 years of experience in hospital revenue cycle, charging, billing edits, charge capture, or a related function required
- Experience with pre-bill account review and correction workflows preferred
- Experience with Medicare and Managed Medicare claim requirements preferred
- Procedural area experience such as OR, Cath Lab, IR, imaging, or cardiology preferred
Knowledge and skills:
- Strong understanding of hospital charge capture and claim flow dependencies
- Working knowledge of CPT/HCPCS, revenue codes, modifiers, and unit-based charging concepts
- Ability to reconcile documentation, itemized charges, and expected services performed
- Strong analytical, organizational, and follow-through skills
- Effective written and verbal communication across clinical and operational teams
- Proficiency with EHR/revenue cycle systems, charging work queues, and account review tools
- Proficiency in Excel and standard reporting/issue tracking tools
- Ability to work independently and as part of a team
- Ability to complete assignments within prescribed accuracy parameters and deadlines
Benefits & Perks
Benefits include:
- Medical plan
- Prescription drug coverage and in-house employee pharmacy
- Dental plan
- Vision plan
- Flexible spending account (FSA)
- Healthcare FSA
- Dependent care FSA
- Retirement savings and investment plan
- Basic group term life and AD&D insurance
- Supplemental group term life and AD&D insurance
- Long-term disability (LTD)
- Short-term disability (STD)
- Employee assistance program
- Commuter transit and parking
- Voluntary life insurance options
- Voluntary legal services
- Voluntary accident, critical illness, and hospital indemnity insurance
- Voluntary identity theft insurance
- Voluntary pet insurance
- Paid time off program
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago