Department
Coding Services
Salary Range
22.99 - 32.18
Job Summary
The Charge Integrity Specialist ensures accurate and complete patient demographic, insurance, and charge information to reduce denials and support optimal reimbursement. This role reviews daily charge submissions, identifies and corrects errors, monitors trends, and collaborates closely with billing and coding teams to maintain high-quality revenue cycle performance.
Essential Functions
- Review charge submissions from providers and charge entry staff for accuracy and completeness.
- Identify, correct, and document errors to ensure clean claim submission.
- Monitor and analyze trends in coding denials, claim edits, and open accounts to identify opportunities for improvement.
- Conduct quality review tracking and auditing to ensure accuracy and compliance.
- Perform charge reconciliation between the EHR and Practice Management systems.
- Audit accounts and resolve billing questions or discrepancies.
- Ensure adherence to insurance carrier claim submission guidelines.
- Update patient accounts with accurate demographic, insurance, and charge information.
- Review and correct electronic claim errors; attach required documentation for payment when necessary.
- Prioritize daily workload to support timely reimbursement and reduce accounts receivable days.
- Communicate trends and findings to supervisors and team members to support process improvement.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the first two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards. Carries out the mission, vision, and quality commitment of Palomar Health Medical Group.
Job Requirements
Minimum Education: High School Diploma or equivalent
Preferred Education: Associate degree in a related field preferred
Minimum Experience: 3 years of related experience in a physician office or medical billing environment with working knowledge of practice management billing systems
Preferred Experience: 5 plus years of experience related experience; NextGen experience.
Required License: Not Applicable
Preferred License: Not Applicable
Required Certification: Not Applicable
Preferred Certification: (CPC) Certified Professional Coder certification
We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.
