Clinical Billing Specialist - Ambulatory Charge Capture Services

Clinical Billing Specialist opportunity in Ambulatory Charge Capture Services department. The ideal candidate will have hands-on experience with physician charging, documentation, and industry-standard billing guidelines. We are seeking someone to join our team who demonstrates strong attention to detail, excellent customer service skills, and effective communication with clinical support teams and management.

A working knowledge of CPT and HCPCS codes, along with experience using Epic EMR and billing systems, is highly preferred.

REMOTE ONLY IN THE STATE OF TEXAS

Technical Charge Capture 

 Performs daily charge capture review to verify clinical center(s) charges are captured in the billing system and are posted in an accurate and timely manner in accordance with institutional policy ADM0403 – Charge Submission and Reconciliation Policy.

Technical charges are reviewed to ensure charges are posted to the correct cost center for revenue mapping using appropriate reports and/or work queues within the EHR and billing systems.

Monitors all charge processes and entries for accuracy and timeliness, research compliance issues, coordinates compliance education and communicates routinely to management by providing recommendations to improve charge capture and reconciliation.

Maintains ongoing education of coding and billing changes in accordance with industry standards as well as Institutional Billing Compliance for CPT- 4 and HCPCS codes and local and federal guidelines.

Knowledgeable review of documentation to support charges with a good understanding of anatomy and medical terminology according to coding/billing and documentation guidelines as applicable to state and federal regulations.

Open Encounters – review daily for open technical encounters.  Contact clinical support team members to resolve any charge or encounter issues.

Initiates charge corrections as appropriate.  Determine corrective action and make necessary updates to resolve errors for appropriate billing of claims.

Communicate any inaccuracies or challenges identified immediately to management which exist in creating barriers to meet institutional policy and timely charge capture.

Maintains standardized workflows and productivity as designated by department management and institutional policies. 

Technical Charge Reconciliation

Reconcile charges daily to identify possible missing charges and ensure accurate and timely charge submission for services rendered in assigned center(s).

Appropriate reconciliation tools will be used daily, including charge reconciliation report(s), other clinical documentation tools and designated work queues to ensure technical charges for services rendered are compliant and documentation is in the EMR to support compliant billing. 

Communicates effectively with nursing staff regarding missing or incomplete charges or documentation to ensure charges are compliant and submitted accurately and timely.

Communicate inaccuracies for resolution and corrective action while working within and across multiple centers in collaboration with management for charges and revenue mapping.

Maintains standardized workflows and productivity as designated by department management and institutional policies.

Assists with training of clinical support teams and other billing specialists and will train and work across different areas as needed. 

Project Management and Follow-Up

Assists in monitoring billing compliance and may assist in conducting staff education sessions as appropriate.

Assist with analysis of Charge Description Master and maintenance to identify new charge services and supplies and ensure accuracy of charge entry on an on-going basis.

 Assists with collecting and summarizing data related to special projects or departmental reporting activity.

Develops, implements, and monitors reconciliation and audit processes to ensure all inpatient and outpatient technical charges are appropriately captured and provides reports of activities as required.

Identifies and communicate process improvement strategies, inaccuracies for resolution and corrective action to management in a timely and routine manner.