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Charge Review Specialist (Remote, can source nationally must have own laptop)
Cook County, IL 60612
6 months (extension or perm placement)
Shift:
- 7:00am- 3:30pm CST
Overview: The Charge Review Specialist t is responsible for the continual maintenance, compliance, and integrity of the Hospital Billing (HB) and Professional Billing (PB) Charge Description Master (CDM), along with related charge review edits and router workqueue logic. Job duties consist of researching current and upcoming applicable regulations and implementing all necessary revisions for optimal revenue preservation, prevention of resource leakage, and compliant billing. Responsibilities include analyzing and configuring charge capture workflows, managing technical charging requests, and the coordination of research, training, and communication with hospital administrators affected. The position collaborates with external pricing vendors to manage and execute the implementation of both facility pricing architecture and professional fee schedules, ensuring accurate CPT/HCPCS and revenue code compatibility for accurate billing detail and compliance regulations. The position requires the continual update of all CDM related policies and procedures as necessary.
Responsibilities:
• Maintains all CDM requests across both Hospital Billing (HB) and Professional Billing (PB) structures for charge code additions, revisions, and deletions.
• Continuously monitors, tracks, and resolves Epic charge review work queues (WQs) and billing exceptions to minimize claim delays and decrease Days in A/R.
• Coordinates with Information Systems to build, test, and implement approved charge codes within the EHR, ensuring seamless integration with Charge Router logic and clinical workflows.
• Thoroughly analyzes each request for accurate pricing alignment based on vendor strategy tables, established fee schedules, CPT/HCPCS, and revenue code compatibility.
• Researches current and future complex Medicare, Medicaid, and commercial payer regulations to ensure optimal revenue preservation, prevent resource leakage, and maintain absolute billing compliance.
• Implements innovative strategies, procedures, and systems to maximize time efficiency and team productivity.
• Maintains a commitment to continuous professional development and ongoing education in coding, compliance, and revenue integrity.
• Executes data-driven revenue integrity initiatives and strategic special projects.
Qualifications:
- With an Associate’s Degree or Higher:
- A minimum of five (5) years of direct, dedicated CDM maintenance experience.
- A minimum of seven (7) years of general healthcare revenue cycle experience (such as Revenue Integrity, Medical Coding, or Billing).
- With a High School Diploma / GED:
- A minimum of eight (8) years of direct, dedicated CDM maintenance experience.
- A minimum of ten (10) years of general healthcare revenue cycle experience (such as Revenue Integrity, Medical Coding or Billing).
- Advanced knowledge of:
- Medical terminology
- Medical billing and reimbursement methodologies
- UB-04 revenue codes
- CPT and HCPCS Level II coding systems
- Applicable coding modifiers
- Epic CDM experience.
- Epic Hospital Billing certification.
- Current AAPC or AHIMA certification.
- Proven ability to organize and track project-type work.
- Working knowledge of CMS/HCFA regulations, payer guidelines, and revenue cycle compliance standards.