RCM Charge Posting Specialist

CF Outsourcing Solutions; Quezon City; Vor Ort; PHP 360.000 - 720.000; Vollzeit

Zusammenfassung

CF Outsourcing Solutions in the Philippines is seeking a RCM Charge Posting Specialist to convert clinical activity into accurate, claim-ready charges across clinic, ASC, lab, anesthesia, radiology, and related services. You will be a control point between documentation, coding and claim submission, ensuring charge completeness and proper diagnosis linkage.

You will review documentation, post charges, validate modifiers and units, and strive to submit within 48 hours of encounters.

Qualifikationen

• College graduate of any four-year course.
• 1-2 years billing/charge-entry experience in physician/ASC/specialty areas.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, modifiers, diagnosis linkage.
• Familiar with payer policies, claim edits/rejections, and revenue-cycle basics.
• eClinicalWorks experience preferred; proficient with Excel and clearinghouse tools.

Aufgaben

• Charge Capture, Validation, and Posting: verify complete charge capture and docs; query when incomplete.
• Claim Readiness and Front-End Denial Prevention: review pre-bill edits and payer requirements; fix front-end errors.
• Audits, Reconciliation, and CI: perform audits, identify patterns, maintain aids, and monitor KPIs.

Kenntnisse

CPT knowledge

HCPCS knowledge

ICD-10-CM knowledge

Diagnosis linkage

Payer policies

Claim edits/rejections

Revenue-cycle workflow

eClinicalWorks (eCW)

Electronic work queues

Ausbildung

College graduate (4-year)

Tools

eClinicalWorks (eCW)

Payer portals

Clearinghouse tools

Excel

Outlook

Jobbeschreibung

Job Summary:

The RCM Charge Posting Specialist converts documented clinical activity into accurate, compliant, claim-ready charges for clinic, ASC, laboratory, anesthesia, radiology, and assigned specialty services. The role is a control point between documentation/coding and claim submission and is accountable for charge completeness, diagnosis linkage, modifiers, payer requirements, work-queue resolution, and timely escalation.

Key Responsibilities:

1. 
   

   1. Charge Capture, Validation, and Posting
   Review encounter and procedure documentation for complete charge capture and sufficient support before posting; query rather than infer when documentation is incomplete.
   Validate date of service, place of service, rendering/billing provider, referring provider when applicable, facility, units, fee schedule, CPT/HCPCS, ICD-10-CM diagnosis linkage, modifiers, and payer sequence before claim creation.
   Manually post and validate ASC, injection, advanced procedure, radiology, and newly implemented procedure charges as assigned.
   Reconcile expected encounters/procedures to posted charges so missing charges are identified, researched, and cleared rather than simply omitted.
   Follow approved coding and charge-entry rules. Do not independently select or change codes when the circumstance requires a coder or provider query.

   
   


2. 
   

   2. Claim Readiness and Front-End Denial Prevention
   Review eCW edits, deficiency reports, claim procedure reports, claim-engine edits, clearinghouse rejections, eligibility or authorization indicators, and other pre-bill exceptions.
   Confirm payer-specific requirements affecting clean claims, including authorization, referral, provider enrollment, timely filing, bundling/edit logic, laterality, units, modifiers, and place-of-service rules.
   Resolve correctable front-end errors and route documentation, coding, authorization, eligibility, credentialing, or system issues to the accountable owner with a due date.
   Company expectation is generally charge submission within 48 hours of the encounter unless an approved hold or documented dependency exists.

   
   


3. 
   

   3. Audits, Reconciliation, and Continuous Improvement
   Perform or support quarterly internal/external provider and charge audits and document findings, corrective actions, and education.
   Identify recurring documentation, coding, payer, insurance, authorization, or system patterns that create claim edits, denials, compliance exposure, or revenue leakage.
   Maintain procedure/payer job aids, approved billing rules, and escalation guides; communicate material rule changes to internal teams.
   RCM Operating Model | Internal Role + Third-Party Support | November 2026
   Performance Standards and Suggested KPIs
   Charge lag: target at least 95% of eligible charges entered/submitted within 48 hours; separately report approved holds.
   Charge accuracy: target at least 98% on audited fields, with 100% expectation for patient/provider identity and material compliance elements.
   Unbilled/missing encounters: daily reconciliation with no unexplained aged encounter beyond the defined escalation threshold.
   First-pass/clearinghouse quality: monitor rejection rate attributable to charge-entry defects and trend by root cause, facility, provider, employee, and vendor.

   
   

Qualifications:

College Graduate of any four-year course
At least 1-2 years of physician, ASC, or specialty billing/charge-entry experience, or an appropriate coding credential with demonstrated claim knowledge.
Strong working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, diagnosis linkage, payer policies, claim edits/rejections, medical terminology, and basic revenue-cycle workflow.
eClinicalWorks experience strongly preferred; proficiency with payer portals, clearinghouse tools, Excel, Outlook, and electronic work queues.
CPC, CCS, CCA, CPB, or comparable credential preferred; pain management and ASC experience strongly preferred.