The Charge Data Specialist is responsible to complete the services of charges posted for areas of Children's National Health System. The Charge Data Specialist provides financial analysis, guidance, and advice to management consistent with standard charge posting practices. The Charge Data Specialist will ensure accurate and timely charge capture and quality assurance processes for professional, technical and facility charge services which are completed daily . The Charge Data Specialist will work directly with managers and physicians to ensure an efficient and seamless process to support charge capture and reconciliation
Qualifications:
Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)
Bachelor's Degree (Preferred)
Minimum Work Experience
5 years experience with medical billing process, health care insurance claim practices and compliance (Required)
Functional Accountabilities
Charge Entry Processing

• Follow all established departmental policies to perform preliminary review of source reports to determine sufficient data are present to upload and process charges.

• Assure all excel files are prepared to include running macros and validate discrepancies in PPM batch to allow releasing of daily batches.

• Determine and adjust needed insurance corrections to include ensuring accounts status are in a billable status.

• Validate and export technical charges in MedAptus outpatient system.

• Work collaboratively with all departments/services of the Children's National Health System to ensure any needed information is obtained for billing process.

• Perform the duties listed above and other duties as assigned.

Program Administration and Analysis

• Perform surveillance of charges to identify any errors; address this information directly with the departments, managers and /or physicians.

• Conduct root cause analysis for issues reducing reimbursement & slowing payment cycle; identify key issues and assist with tracking, trending and reporting.

• Audit performance by registration staff across the enterprise and communicate findings to the appropriate department leaders.

• Present data and analysis to all levels of management and/or physicians for trends and billing issues.

• Assist in the development of solutions, training & education to resolve issues and share data with staff and management

• Provide training and education to new employees and leadership as needed.

Medical Coding Record Keeping

• Ensure procedure and diagnosis codes, as selected by the treating physician, are billable prior to releasing charges; correspond with physicians and coding managers as needed to report coding issues.

• Develop detailed knowledge of internal billing coding to identify breakdowns & resolutions.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification

• Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others' ideas and opinions

Performance Improvement/Problem-solving

• Contribute to a positive work environment

• Demonstrate flexibility and willingness to change

• Identify opportunities to improve clinical and administrative processes

• Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

• Use resources efficiently

• Search for less costly ways of doing things

Safety

• Speak up when team members appear to exhibit unsafe behavior or performance

• Continuously validate and verify information needed for decision making or documentation

• Stop in the face of uncertainty and takes time to resolve the situation

• Demonstrate accurate, clear and timely verbal and written communication

• Actively promote safety for patients, families, visitors and co-workers

• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance