Charge Review/Entry Specialist

Description:

The Charge Review / Charge Entry Specialist is responsible for accurately reviewing and entering patient charges into the billing system to support timely, compliant claim submission and optimal reimbursement. This role validates charge documentation, applies correct codes and charge rules per client and payer requirements, and resolves discrepancies by coordinating with clinical and billing teams.

Responsibilities:

• 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.

Qualifications:

• High school diploma or equivalent required; associate degree in healthcare administration, business, or related field favorable.
• 1+ year of experience 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 Qualifications:

• 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.

Physical Demands:

· Work may require sitting for long periods of time. 

· Occasionally lifting files or paper. 

· Operating a computer, keyboard, telephone, fax or other such office equipment through a normal business day. 

· Vision must be correctable to 20/20 for viewing information on computer screen and reading information in a paper format. 

· Hearing must be in the normal range for telephone contacts.

· Will require viewing computer screen and typing on a keyboard for prolonged periods of time.