Charge Validation Specialist (Engineering)

Charge Validation Specialist
Job Summary

The Charge Validation Specialist is responsible for ensuring accurate and efficient charge capture by verifying and posting charges from the electronic health record (EHR). This role requires a strong understanding of ICD-10 diagnosis codes, CPT procedural codes, and payor-specific requirements to ensure compliance and minimize claim denials. The Specialist works collaboratively with physicians, scribes, and the revenue cycle team to improve documentation, enhance workflows, and ensure timely charge posting within a three-day lag.

This is a Remote position; however, all candidates considered for this position must currently reside within Central California.

Duties/Responsibilities:
Charge Posting and Coding Accuracy
Post charges from the EHR with accuracy and attention to detail.
Verify that ICD-10 diagnosis codes support medical necessity for corresponding CPT codes based on clinical documentation.
Append appropriate modifiers to CPT codes in accordance with payor and plan-specific requirements.

Documentation Review and Collaboration
Work closely with physicians and scribes to review documentation for completeness and accuracy, driving improvements in coding and charge capture processes.
Proactively monitor outstanding or missing charges for patients, ensuring charts are completed, signed off, and charges posted promptly.
Provide feedback and education to physicians and scribes to enhance documentation practices, including clarifying ambiguous or nonspecific entries.

Compliance and Denial Prevention
Ensure coding aligns with legal and regulatory standards, including Medicare and payor-specific guidelines, to minimize claim denials.
Review and reconcile drug inventory data with EHR records and PODIS inventory management system for applicable charges.

Reporting and Analytics
Generate and analyze reports on metrics such as charge lag, denied claims, and documentation issues for management review.
Identify trends or recurring issues in coding and documentation, presenting actionable recommendations to leadership.

Continuing Education and Training
Stay current with coding regulations and industry trends through workshops, newsletters, and ongoing education.
Collaborate with the Revenue Cycle Manager to create and deliver training materials and sessions for physicians and staff on coding, documentation, and compliance best practices.

Process Improvement
Participate in refining workflows and processes to optimize charge capture and reduce delays.
Act as a subject matter expert, providing guidance and recommendations on coding-related challenges.
Misc: Executes supplementary tasks as assigned to meet departmental and organizational needs.