Claim/Charge Edit Specialist

Claim/Charge Edit Specialist is responsible for reviewing clinical documentation to ensure timely, accurate, and compliant charge capture and processes paper and electronic claims to payers with full and complete information to satisfy and facilitate the claim for payment. Claim/Charge Edit Specialist works closely with Physician Practices as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges. In addition, works payer acceptance/reject reports and collaborates with cross-campus counterpart(s) and Physician Practice to ensure clinical documentation in high risk areas is consistent and complete, while also producing accurate and timely claims in order to prevent denials and maximize reimbursement. The Claim/Charge Edit Specialist collaborates with cross-campus counterpart(s) to ensure consistency in processes in such a manner that each individual can act as a back-up for the other to ensure seamless charge capture in high risk areas when one individual is out.

Duties include:

- Charge entry

- Ensuring correctness of coding in the CDM and clinical documentation

- Providing ongoing education to charging departments, while also being responsible for working claim edits within the patient accounting system and claim scrubber edits prior to final submission.