Job Summary

The Operating Room Charge Review Specialist is responsible for ensuring accuracy and completeness in the billing process related to operating room procedures and charges. They meticulously review charges, documentation, supplies and implants used, and coding to ensure compliance with regulatory standards and maximize revenue capture for the healthcare facility.

COMPANY DESCRIPTION

Frye Regional Medical Center, located in the beautiful foothills of North Carolina is a 355-bed acute care hospital, 81-bed Behavioral Health facility and more than 70 primary and specialty care providers.

Essential Functions

• Reviewing Charges:
• Review operating room charges to ensure accuracy and completeness.
• Verify that charges align with documentation of supplies and implants used and coding guidelines.
• Identify any discrepancies or inconsistencies and take appropriate action for resolution.
• Documentation Analysis:
• Analyze medical records and operative reports to validate the necessity and appropriateness of charges.
• Ensure that documentation supports the billed procedures and services.
• Collaborate with healthcare providers to clarify documentation as needed.
• Compliance Assurance:
• Ensure compliance with regulatory requirements, coding guidelines, and payer policies.
• Stay updated on changes in coding and billing regulations related to operating room procedures.
• Identify potential compliance risks and recommend corrective actions to mitigate them.
• Revenue Optimization:
• Identify opportunities to optimize revenue capture through accurate charge capture and documentation.
• Collaborate with revenue cycle management teams to implement best practices for maximizing reimbursement.
• Provide feedback and recommendations for process improvements to enhance revenue integrity.
• Quality Assurance:
• Conduct regular audits and quality reviews of operating room charges.
• Develop and maintain quality assurance processes to monitor the accuracy of billing practices.
• Implement corrective measures and provide training to staff as needed to address identified issues.

Benefits - Wide range of benefits options!

• Here at Frye, you choose your own Medical, Dental, and Vision plans from a variety of competitive options that give you the coverage that best fits your needs.
• HSA
• 401(K) retirement plan contributions
• Generous Paid Time Off
• Accident & Critical Illness Insurance
• Prescription Assistance with OptumRx
• Income protection programs for the entire family such as life insurance, Short/Long-term Disability, and Identity Theft.
• Employee Assistance program at no cost to you to provide emotional, legal, financial, and daily life support for your entire household. Services are available 24 hrs. a day, 7 days a week.
• Free travel and entertainment discount program to ensure you enjoy your time away from work.

Minimum Education

• Associates Degree Required.
• Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferred
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred.

Minimum Work Experience

• Experience in healthcare billing, coding, or revenue cycle management, with specific knowledge of operating room procedures.
• Proficiency in medical terminology, coding systems (e.g., ICD-10, CPT), and billing software.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.