Charge Capture Analyst, FT, Days

Prisma Health; Greenville (SC); On-site; USD 65,000 - 90,000; Full time

Job summary

Prisma Health is seeking a Revenue Integrity Specialist to monitor charge capture, perform audits, and ensure compliance with billing policies. You will validate diagnoses and procedures, advise on correct charge codes, and support monthly and quarterly reconciliations.

The role requires healthcare revenue cycle experience and familiarity with coding guidelines, with opportunities to collaborate with vendors on optimization projects.

Qualifications

• Three (3) years of Health care revenue cycle experience.
• Job Related Certification in one of RHIT, RHIA, CCS, CPC, CRCA/CRCR, or CBCS preferred.
• Understanding of OPPS, IPPS, ICD10 Coding, HCPCS/CPT Coding, revenue cycle processes.

Responsibilities

• Monitor charge capture, revenue reconciliation and revenue trending across Prisma Health.
• Validate principal and secondary diagnoses, procedures and CPT/HCPCS codes.
• Advise revenue owners on proper charge codes and opportunities to increase revenue.

Skills

OPPS/IPPS knowledge

ICD10 Coding

CPT/HCPCS Coding

Revenue cycle processes

Charge review

Education

High School Diploma

Associate degree

Health Science/Business/Coding Certificate

Tools

Epic

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Interacts with departmental revenue owners to monitor charge capture, revenue reconciliation and revenue trending across Prisma Health. Completes focused charge review audits for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Works assigned Epic charge review and billing work queues to meet our compliant standardized min daytime frame, ensuring appropriate medical documentation exists to support charge capture compliance.
• Validates assigned principal diagnosis, all secondary diagnoses, principal procedures, and all secondary procedures and CPT/HCPCs codes.
• Advises departmental revenue owners and their staff on proper usage of charge codes, identifies opportunities for capturing additional revenue in accordance with payer guidelines and develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Reviews and applies appropriate billing guidelines, state and federal regulations, and third-party billing rules/coverage.
• Completes internal charge review audits for assigned clinical departments to ensure that charges are generated in accordance with established policies and timeframes. Assist with monthly, quarterly, and yearly Charge capture revenue reconciliation auditing, reporting and education.
• Partners with vendors for optimization projects to complete data review, auditing, and testing.
• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Three (3) years of Health care revenue cycle related experience

In Lieu Of

• In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Associate degree
• In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Health Science/Business/Coding Certificate and two (2) years healthcare revenue cycle related experience

Required Certifications, Registrations, Licenses

• Job Related Certification in one of the following: RHIT, RHIA, CCS, CPC, CRCA/CRCR, or CBCS preferred.

Knowledge, Skills and Abilities

• Understanding of OPPS, IPPS, ICD10 Coding, HCPCS/CPT Coding, revenue cycle processes.
• Ability to understand and apply National and Local Coverage Determination to complete assigned work queues and educate facility departments routinely.

Work Shift

Day (United States of America)

Location

Patewood Outpt Ctr/Med Offices

Facility

Corporate

Department

Revenue Integrity

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.