Healthcare Charge Review/Entry Specialist

Job Description

REQUIREMENTS

• High school diploma or equivalent required; associate degree in healthcare administration, business, or related field favorable.
• 1+ year of experience required in healthcare billing, charge entry, charge capture, or revenue cycle operations (clinic, hospital, or medical billing company environment).
• Working knowledge of medical terminology and basic reimbursement concepts.
• Familiarity with CPT, HCPCS, ICD-10-CM, modifiers, units, and common claim form requirements as applicable to the client specialty.
• Experience using PM/EHR systems and Microsoft Office (Excel, Outlook, Teams); ability to learn new client systems quickly.
• Strong attention to detail with a high level of accuracy and the ability to meet daily productivity and quality metrics.
• Ability to research issues, follow written procedures, and document work clearly.
• Strong communication and customer service skills for interacting with internal teams and external providers.
• Demonstrated commitment to confidentiality and compliance (HIPAA) and adherence to standard policies and procedures.

Preferred :

• Experience with multi-specialty billing and high-volume charge entry workflows.
• Prior experience working with charge reconciliation, charge lag reporting, or charge capture audits.
• Knowledge of payer-specific billing rules (e.g., Medicare, Medicaid, commercial) and authorization/referral impacts on billing.

RESPONSIBILTIES

• Review all supporting documentation to confirm all billable services are captured.
• Enter charges into the practice management (PM) and/or electronic health record (EHR) system accurately and within required turnaround times.
• Validate required billing elements (date of service, rendering/provider, location, diagnosis pointers, units, modifiers, NDC/lot where applicable) prior to claim submission.
• Identify, research, and correct charge discrepancies such as missing charges, duplicate charges, incorrect units, invalid modifiers, or mismatched diagnosis-to-procedure linkage.
• Apply client-specific charge rules, fee schedules, and payer billing guidelines; escalate unusual scenarios or compliance concerns appropriately.
• Work charge edits, hold queues, and worklists; document actions taken and maintain clear audit trails in the system.
• Communicate with providers, staff, and internal teams to obtain missing information and resolve documentation issues.
• Support claim quality by reducing downstream rework, denials, and payment delays through proactive charge accuracy checks.
• Maintain productivity and quality standards.
• Participate in training, and follow HIPAA and company policies for PHI.
• Assist with periodic audits, reconciliation, and reporting
• Perform all other functionally related duties and special projects as assigned and needed.

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