GENERAL SUMMARY: Ensures accurate and compliant charge capture, billing, and revenue processes across clinical and operational departments. Reviews and resolves pre-bill edits, analyzes discrepancies, and collaborates with teams to improve documentation and charging practices. Maintains chargemaster integrity, supports regulatory compliance, and conducts audits to ensure appropriate reimbursement. Uses data analysis and cross-functional coordination to identify trends, implement process improvements, and optimize overall revenue cycle performance. PRINCIPAL JOB FUNCTIONS:
*Commits to the mission, vision, beliefs and consistently demonstrates our core values.
*Reviews and resolves charge capture issues, pre-bill edits, and billing discrepancies to ensure accurate reimbursement.
*Analyzes charge review work queues and reporting data to identify trends and root causes.
*Verifies billing data accuracy and ensures compliance with payer and regulatory requirements.
*Collaborates with clinical and operational teams to correct errors and improve documentation and workflows.
*Maintains and updates chargemaster data to support compliant and accurate charging practices.
*Conducts audits of accounts and documentation to validate appropriate charge capture and billing.
*Provides education to departments on documentation, coding, and revenue integrity practices.
*Monitors regulatory updates and implements changes to maintain compliance with billing requirements.
*Uses reporting and data analysis tools to support revenue optimization and performance improvement.
Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
Participates in meetings, committees and department projects as assigned.
Performs other related projects and duties as assigned.
(Essential Job functions are marked with an asterisk "*"). REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of claims practices including governmental and non-governmental billing.
Knowledge of revenue cycle processes, hospital billing, Charge Description Master (CDM), and UB billing requirements.
Knowledge of coding systems, reimbursement methodologies, and regulatory guidelines, including CPT, HCPCS, NCCI edits, Medicare LCDs/NCDs, DRG, OPPS, and managed care reimbursement.
Knowledge of hospital compliance requirements and applicable state and federal healthcare regulations.
Knowledge of denial management processes, including appeals, root cause analysis, and process improvement strategies.
Knowledge of charge master maintenance processes, including the creation, modification, and deletion of charge codes.
Ability to review, analyze, interpret, and communicate managed care contracts, billing guidelines, and regulatory requirements across the organization.
Ability to review and interpret detailed medical record documentation and effectively communicate findings with medical staff, leadership, and revenue cycle personnel.
Knowledge of computer systems, software applications, and reporting tools relevant to revenue cycle and billing functions.
Ability to research and apply regulatory requirements, billing rules, and claims processing guidelines.
Ability to analyze data, identify trends, solve problems, and exercise independent critical thinking and sound judgment.
Ability to communicate effectively, build collaborative relationships, maintain confidentiality, prioritize workload, and work independently with minimal supervision.
EDUCATION AND EXPERIENCE: High school diploma or equivalent required. Three (3) years of experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge, revenue integrity; charge reconciliation; charge compliance; charge auditing; CDM management required. PHYSICAL REQUIREMENTS: (Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.) (DOT) - Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. |
Bryan Health
Sep 28, 2026