Charge Validation Specialist

California Retina Consultants; California (MO); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider is seeking a Charge Validation Specialist responsible for ensuring accurate charge capture and compliance with coding standards. This remote position requires expertise in ICD-10 and CPT coding, collaboration with healthcare teams, and a commitment to accuracy. Candidates must possess a strong background in medical coding, along with education and experience in the field to effectively enhance workflows and reduce claim denials.

Benefits

Medical Insurance Plans

Vision Insurance Plan

Dental Insurance Plan

401K Contribution

Life Insurance

Sick, Vacation, and Holiday Pay

Qualifications

• Minimum 2–3 years of experience in medical coding and charge posting.
• Hands-on experience with ICD-10-CM, CPT coding, and applying payor-specific modifiers.
• Proficiency with EHR systems and medical billing software.

Responsibilities

• Post charges from the EHR with accuracy and attention to detail.
• Work closely with physicians and scribes to improve documentation.
• Generate and analyze reports on charge lag and denied claims.

Skills

ICD-10 coding

CPT coding

Documentation Review

Analytical Skills

Education

Certification in medical coding (e.g., CPC, COC, or CCS)

High school diploma or equivalent

Associate’s or Bachelor’s degree in healthcare administration or related field

Tools

EHR systems

medical coding software

Job description

3 days ago Be among the first 25 applicants

California Retina Consultants provided pay range

This range is provided by California Retina Consultants. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$24.00/hr - $27.00/hr

Direct message the job poster from California Retina Consultants

Talent Acquisition Specialist at California Retina Consultants

Charge Validation Specialist

Job Summary

The Charge Validation Specialist is responsible for ensuring accurate and efficient charge capture by verifying and posting charges from the electronic health record (EHR). This role requires a strong understanding of ICD-10 diagnosis codes, CPT procedural codes, and payor-specific requirements to ensure compliance and minimize claim denials. The Specialist works collaboratively with physicians, scribes, and the revenue cycle team to improve documentation, enhance workflows, and ensure timely charge posting within a three-day lag.

This is a Remote position; however, all candidates considered for this position must currently reside within Central California.

Duties/Responsibilities:

Charge Posting and Coding Accuracy

• Post charges from the EHR with accuracy and attention to detail.
• Verify that ICD-10 diagnosis codes support medical necessity for corresponding CPT codes based on clinical documentation.
• Append appropriate modifiers to CPT codes in accordance with payor and plan-specific requirements.

Documentation Review and Collaboration

• Work closely with physicians and scribes to review documentation for completeness and accuracy, driving improvements in coding and charge capture processes.
• Proactively monitor outstanding or missing charges for patients, ensuring charts are completed, signed off, and charges posted promptly.
• Provide feedback and education to physicians and scribes to enhance documentation practices, including clarifying ambiguous or nonspecific entries.

Compliance and Denial Prevention

• Ensure coding aligns with legal and regulatory standards, including Medicare and payor-specific guidelines, to minimize claim denials.
• Review and reconcile drug inventory data with EHR records and PODIS inventory management system for applicable charges.

Reporting and Analytics

• Generate and analyze reports on metrics such as charge lag, denied claims, and documentation issues for management review.
• Identify trends or recurring issues in coding and documentation, presenting actionable recommendations to leadership.

Continuing Education and Training

• Stay current with coding regulations and industry trends through workshops, newsletters, and ongoing education.
• Collaborate with the Revenue Cycle Manager to create and deliver training materials and sessions for physicians and staff on coding, documentation, and compliance best practices.

Process Improvement

• Participate in refining workflows and processes to optimize charge capture and reduce delays.
• Act as a subject matter expert, providing guidance and recommendations on coding-related challenges.
• Misc: Executes supplementary tasks as assigned to meet departmental and organizational needs.

About the Candidate

Preferred Skills/Abilities:

• Proficiency with EHR systems, medical coding software, and revenue cycle management processes.
• Strong knowledge of ICD-10-CM, CPT, and modifier usage, with an emphasis on payor-specific coding guidelines.
• Experience in a retina or ophthalmology clinic setting is a plus.
• Excellent communication and collaboration skills to work effectively with clinical and administrative teams.

Education and Experience:

• High school diploma or equivalent required.
• Certification in medical coding (e.g., CPC, COC, or CCS) strongly preferred.
• Associate’s or Bachelor’s degree in healthcare administration, medical billing/coding, or a related field is a plus.
• Minimum of 2–3 years of experience in medical coding and charge posting, preferably in a specialty practice such as ophthalmology or retina care.
• Hands-on experience with ICD-10-CM, CPT coding, and applying payor-specific modifiers.
• Proficiency with electronic health records (EHR) systems and medical billing software; experience with Nextech & NextGen is a plus.
• Demonstrated ability to interpret and apply documentation guidelines to ensure accurate and compliant coding.
• Familiarity with Medicare and private payor policies and regulations.

Skills and Competencies:

• Strong analytical and problem-solving skills to ensure accuracy and compliance in coding and charge posting.
• Excellent communication and collaboration skills to work effectively with physicians, scribes, and revenue cycle teams.
• Ability to manage time effectively and prioritize tasks to meet deadlines, such as maintaining a three-day charge lag.
• Commitment to ongoing education and staying current on coding and regulatory changes.

Who We Are

California Retina Consultants (CRC) is part of Retina Consultants of America (RCA), the largest network of leading retina specialists with the mission of saving sight and improving patient lives through innovation and the highest quality care. Through RCA's physician-centered practice management model, physicians continue to drive clinical and practice culture while benefiting from the available business expertise, resources and shared best practices.

• Medical Insurance Plans
• Vision Insurance Plan
• Dental Insurance Plan
• 401K Contribution
• Life Insurance
• Sick, Vacation, and Holiday Pay

Equal Opportunity Employer

California Retina Consultants is proud to be an Equal Employment Opportunity and an Affirmative Action Employer. We are committed to creating an inclusive work environment that celebrates diversity.

All offers are contingent upon satisfactory background check and pre-employment drug screen.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  General Business

• Industries

  Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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