Full employer posting
Documentation Review & Charge Capture Review provider clinical encounter notes, operative reports, bedside procedure logs, and diagnostic reports to verify that documentation is associated with billable services. Cross-reference provider schedules, facility face sheets, and operative schedules against entered encounters to prevent missed charges, uncaptured revenue, and delayed billing. Initiate formal provider queries when documentation is incomplete, illegible, ambiguous, or fails to substantiate the level of service or procedures rendered.
Charge Entry & Modifier Assignment Enter, batch, and post professional and facility-level procedural charges (CPT/HCPCS Level II) and diagnostic codes (ICD-10-CM) into the practice management system within target turnaround times. Ensure proper sequence of primary, secondary, and tertiary diagnosis pointers across all line-item charges. Review and assign first-level anatomical and procedural modifiers based directly on chart documentation, including: Laterality & Anatomical Sites: RT (Right), LT (Left), 50 (Bilateral).
Digits & Sub-sites: E1–E4 (Eyelids), FA–F9 (Fingers), TA–T9 (Toes). Distinct & Significant Procedures: 59, XE, XP, XS, XU (Distinct Procedural Services), 25 (Separately Identifiable Evaluation & Management), 76/77 (Repeat Procedures). Procedural Relationships: 51 (Multiple Procedures), 52/53 (Reduced/Discontinued Services), 22 (Increased Procedural Services).
Appropriate distinction between diagnostic and screening procedures. Work Queue & Pre-Bill Edit Resolution Investigate and correct front-end billing rejections stemming from National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, Medically Unlikely Edits (MUEs), and payer-specific medical necessity rules. Collaborate with denial management and billing staff to identify recurring charge entry errors and update front-end workflows accordingly.
Compliance & Data Integrity Adhere strictly to CMS, HIPAA, OIG, and commercial payer guidelines regarding unbundling, upcoding, and medical necessity. Keep current on annual coding updates, specialty-specific billing regulations, and changes to local and national coverage determinations (LCDs/NCDs). Participate in regular internal revenue cycle quality audits and meet established benchmarks for accuracy and volume.
About the role
Review provider clinical encounter notes, operative reports, bedside procedure logs, and diagnostic reports to verify that documentation is associated with billable services.