Revenue Charge Specialist

Inspire health. Serve with compassion. Be the difference.

Job Summary

Ensures complete and accurate revenue integrity charging standards for Perioperative Services for IP/OP surgery centers. Follows compliant charge capture program and billing practices in accordance with Medicare, Medicaid or Third Party payor guidelines.

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.

• Daily audits charge and enters facility fees for Perioperative Services into the Perioperative Information system to include surgery, preop, and recovery.  Analyzes relevant nursing documentation and encounter forms to identify discrepancies in order to accurately capture all revenue. Enters or credits all implant and supply charges as required into the OPTIFLEX and Demand bill systems assuring accurate and completes charge capture.  

• Performs daily audits of revenue cycle charge proof reports and Bipas against surgeon's operative note and all other nursing documentation to assure timely, complete and accurate billing for compliance and maximum reimbursement within AR timelines. Reviews procedures for appropriate CPT codes based on all documentation to assure correct facility fee.  The auditing process includes accessing multiple downstream systems for compliant charge capture and documentation integrity.

• Follows established department guidelines and consistently, appropriately and proactively notifies nurses of errors in both documentation and charge capture for correction and clarification to assure both documentation and revenue cycle integrity.  

• Daily records clinical charge errors discovered through detailed audits processes into department access data base to provide RN Perioperative Business Services documentation necessary in the development of in-services and one on one coaching for the clinical staff. 

• Monitors, researches and responds to periodic billing problems for Perioperative Services including identifying supply/implants needing item and charge numbers and for CCA and Xclaim inquiries. Follows up and resolves problems in a timely manner communicating effectively with coworkers, nurses and management staff. RN Perioperative Business Services.  For late charges, follows established protocols.  

• Assists in annual review of department policies and procedures.  Assumes additional projects as assigned by management.   

• Performs other duties as assigned.

Supervisory/Management Responsibilities

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

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned

• Experience - Three (3) years health care revenue cycle

In Lieu Of

• In lieu of the experience and/or educational requirements indicated above a combination of education, training, and/or experience may be considered an equivalent substitution:    Coding certification from an accredited organization: AAPC, AHIMA or ACMCS or (5) years in a health care facility or physician office practice to include working knowledge of ICD9-CM, CPT/HCPCS,UB-04 revenue codes and /or denials

• In lieu of the experience and/or educational requirements indicated above a combination of education, training, and/or experience may be considered an equivalent substitution: Five (5) years in Health Information Management with working knowledge of ICD9-CM,CPT/HCPCS.     

• Team members employed in this job prior to July 1, 2020, are grandfathered under prior educational and experience requirements.  In addition, team members must be certification eligible and will have one year to obtain required certification(s). 

Required Certifications, Registrations, Licenses

• CPC to be obtained 2 years after date of hire preferred

Knowledge, Skills and Abilities

• Knowledge of office equipment (fax/copier)

• Proficient computer skills (word processing, spreadsheets, databases)

• Data entry skills

• Mathematical skills

• Typing skills

• Working knowledge of medical terminology, anatomy, physiology. Which can be obtained by on-the job training or through college courses preferred

• Familiarity with ICD9-CM, CPT/HCPCS and UB04 codes preferred

Work Shift

Day (United States of America)

Location

Greenville Memorial Hospital

Facility

Greenville Memorial Hospital

Department

Nursing Administration

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.