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Job SummaryThe Charge Capture Analyst interacts with departmental revenue owners to monitor charge capture, revenue reconciliation and revenue trending across Prisma Health. This role 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.
- Advises departmental revenue owners and staff on proper usage of charge codes with medical record analysis. Demonstrates the ability to interact with diverse groups at all levels of the organization by providing guidance and education when needed.
- Reviews and applies appropriate billing guidelines, state and federal regulations, and third party billing rules/coverage. Identifies opportunities for capturing additional revenue in accordance with these guidelines.
- Monitors daily charge capture, revenue reconciliation, late charge trending, revenue trending, and work queues for assigned departmental revenue owners for compliant charge capture detail and documentation integrity. Identifies operational trends and benchmarks.
- Monitors and works with Revenue Cycle and IT staff to resolve accounts that are not routing through the HB Revenue Cycle process.
- Validates assigned principal diagnosis, all secondary diagnoses, principal procedures and all secondary procedures and CPT/HCPCs codes.
- Develops data requirements and works with analytics groups to complete internal charge review audits for assigned clinical departments to ensure that charges are generated in accordance with established policies and timeframes.
- Assists supervisor in addressing questions from staff regarding coding and billing issues. Reviews escalated accounts and issues.
- Participates in system conversions, implementations and upgrades. Provides coding and reimbursement revenue of all proposed build. Completes assigned tasks in a timely manner. Engages in Epic Implementation “go-live charging hub”, and participates in Revenue Management Task Force. Works with CDM, clinical departments, and I/S to ensure Epic and the system build are in place for charge entry and charge capture of provided services.
This is a non-management job that will report to a supervisor, manager, director, or executive.
- High School diploma or equivalent
- 5 years of healthcare revenue cycle experience
Job Related Certification in one of the following: RHIT, RHIA, CCS, CPC, or CRCA/CRCR.
In Lieu Of The Above Minimum Requirements
Associate's Degree and 4 years of healthcare revenue cycle experience + 2 years of charge description master/revenue integrity experience or Bachelor's Degree and 2 years charge description master/revenue integrity experience.
Other Required Skills and Experience
General understanding of OPPS, IPPS, ICD10 Coding, HCPCS/CPT Coding, revenue cycle processes required.
Work ShiftDay (United States of America)
Location1200 Colonial Life Blvd
Department70019080 Revenue Integrity-Midlands
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.
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