Charge Capture Analyst, FT, Days, - Remote

Davita Inc.; Greenville (SC); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a professional for revenue cycle management. This role involves monitoring charge capture, validating diagnoses, and ensuring compliance with billing guidelines to enhance revenue generation. The ideal candidate will possess a strong background in healthcare revenue processes, relevant certifications, and a commitment to organizational values.

Qualifications

• Three years of healthcare revenue cycle related experience required.
• Job Related Certification in RHIT, RHIA, CCS, CPC, CRCA/CRCR, or CBCS preferred.

Responsibilities

• Monitor charge capture and revenue reconciliation across departments.
• Validate diagnosis and procedures for charge capture compliance.
• Advise on proper usage of charge codes and opportunities for additional revenue capture.

Skills

Understanding of OPPS

Understanding of IPPS

ICD10 Coding

HCPCS/CPT Coding

Revenue cycle processes

Education

High School diploma or equivalent

Associate degree

Health Science/Business/Coding Certificate

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 values: 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

Cancer Centers - Faris Road

Facility

1008 Greenville Memorial Hospital

Department

10559151 Revenue Cycle-Cancer Institute-CIF

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.