CHARGE CAPTURE SPECIALIST

Description

SUMMARY  

The Charge Capture Specialist is responsible for reviewing charges, coding, and documentation to ensure compliance with payer requirements, optimizing revenue, and minimizing billing errors. This position collaborates with clinical, billing, and coding teams to resolve discrepancies and identify opportunities for charge capture improvement.

PRINCIPAL ACTIVITIES & RESPONSIBILITIES:

• Ensures accurate and timely charge capture processes for assigned service lines, maintaining standardization across relevant areas. 
• Reconciles charges with source documents to ensure completeness and accuracy, while monitoring compliance with internal procedures and reporting issues of non-compliance. 
• Reviews patient records and medical documentation to verify that all services are captured and documented in compliance with healthcare regulations and payer requirements. 
•  Identifies billing errors or omissions and collaborates with relevant teams to correct and revise them promptly.
• Works closely with physicians, clinicians, and other healthcare staff to clarify discrepancies or missing information related to charge documentation.
• Trains staff involved in billing data entry and charge reconciliation to ensure procedures are understood and charges are accurate, timely, complete, and well-documented. 
• Prepares reports and provides summary information to the Revenue Cycle team to ensure system-wide charge capture, proper billing, reimbursement, and compliance. 
• Provides expertise to implement process improvements and system updates to prevent charge errors and omissions, while assisting in the maintenance of clinical charging systems.  
• Maintains an up-to-date understanding of industry standards, payer policies, and coding changes to ensure compliance and accuracy. 
• Ensures adherence to all privacy regulations, including HIPAA, when handling patient data and documentation.
• Collaborates efficiently and effectively while consistently demonstrating professionalism and maintaining positive, respectful relationships with internal teams, external partners, and Tribal members.
• Other duties as directed by management.  

LEVEL OF AUTHORITY & RESTRICTIONS:

• This position requires working independently without overseeing others, with minimal authority in decision-making.

PHYSICAL & MENTAL DEMANDS:

• Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms. 
• Must be able to stand, walk, reach with hands and arms, and climb or balance.
• Must be able to sit and type for long periods of time.
• Vision abilities required by this job include close vision and the ability to adjust focus. 
• May be required to push, pull, lift, and/or carry up to 40 pounds.

WORKING CONDITIONS & ENVIRONMENT:

• Office setting is the standard environment.
• Moderate noise level with frequent interruptions or distractions.
• Must be willing and able to travel both locally and within the CTCLUSI service delivery area. 
• May be required to attend meetings, conferences and Tribal events.

Requirements

MINIMUM JOB REQUIREMENTS:

• Must be 18 years of age or older.
• High School Diploma or equivalent.
• Two (2) years of experience in healthcare revenue cycle operations, including professional charging, claims billing, coding, Charge Master maintenance, audit support, accounts payable/receivable, and regulatory experience.
• Advanced knowledge of revenue cycle processes and medical billing to include CDM, UB, RAs and 1500.
• Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
• Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
• Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
• Demonstrates excellent interpersonal skills and the ability to interact effectively with a variety of individuals and groups.
• Excellent organizational and communication skills.
• Demonstrates the ability to work independently and make sound independent judgment and have strong decision-making abilities.
• Experience and proficiency in the use of Microsoft products (Excel, Outlook, PowerPoint, Word, etc).
• Ability to communicate clearly and effectively in English, verbally, in writing or by other acceptable means. 
• This position is considered a non-covered role per the CTCLUSI Background Investigations Policy. A state criminal background check and fingerprint-based background check will be required as a condition of employment.
• This position is subject to pre-employment and other authorized drug and alcohol testing in accordance with company policy. 
• Must have employment eligibility in the U.S.
• Indian preference will be observed in the hiring process.