Charge Capture Specialist

Charge Capture Specialist

Department: Revenue Cycle

Program: Health Systems

Reports To: Revenue Integrity Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Schedule: 40 Hours/52 Weeks

Preference: TERO Ordinance 2017-01, P.L. 93-638

Job Summary

A Charge Capture Specialist is responsible for collaborating with all Health Systems Departments to ensure accurate and timely capture of un'ina (patient) charges. In order to accurately capture un'ina (patient) charges the Charge Capture Specialist reviews medical records, reviews claims to verify the correct billing codes are documented and identify any discrepancies or missing information to optimize revenue collection all while adhering to compliance regulations.

Essential Functions

• Collaborates with Health Systems staff on accurately, completely, and timely entering all un'ina (patient) related charges into appropriate electronic health record system
• Reviews charges to ensure clinical documentation within medical record supports each charge for claims submitted and payments received
• Utilizes system reports to verify and reconcile un'ina (patient) charge activity
• Identifies and resolves charge capture errors for all Health Systems Department claims in a timely manner
• Collaborates with Revenue Cycle team to maintain the charge master
• Collaborates with the Central Billing Office team to ensure claims are coded and charges are captured and in alignment with best practices
• Collaborates with Revenue Integrity Supervisor to provide training to all Health Systems Providers on charge capture compliance
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.

Working Conditions

Lifting Requirements

• Light work - Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg control requires exertion of forces greater than that of sedentary work and if the worker sits most of the time, the job is considered light work.

Physical Requirements

• Stand or Sit (Stationary position)
• Walk (Move, Traverse)
• Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
• Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
• See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
• Repetitive Motion

OSHA Categories

• Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid

Equipment and Tools

Equipment used for job: Computer, phone, scanner, copier, electronic health records

Travel

• Local
• In-State

Qualifications

Education

• High School Diploma or GED

Experience

• Two (2) years medical charge and billing
• Proficiency in electronic health records

Preferred

• Knowledge and experience working with cultural diversities
• Associates degree in related field
• Experience with Indian Health Services facilities operations
• At least one of the following certifications: Certified Professional Coder Certified Professional Biller (CPC CPB) or Billing Coding Specialist Certification (BCSC)

Special Skills

• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Ability to multi-task, work independently, and meet deadlines
• Excellent verbal and written communication skills for collaboration with team members, other departments, and external stakeholders
• Knowledge of the following healthcare services: Primary Care, Dental, Optometry, Laboratory, Therapy Services, Radiology, Pharmacy, Behavioral Health, etc
• In-depth knowledge of health care billing practices, coding standards (such as ICD-10, CPT, and insurance claim processing
• Knowledge of electronic health records
• Familiarity with federal and state healthcare billing regulations and compliance requirements, including HIPAA and insurance guidelines
• Knowledge of Healthcare Common Procedure Coding System (HCPCS) guidelines
• Ability to perform reporting functions to include reconciliation, create and analyze reports
• General understanding of modifiers and medical terminology

This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.

• Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.