Charge Entry and Eligibility Specialist

Position Summary

The Charge Entry and Eligibility Specialist is responsible for ensuring the accurate and timely entry of medical charges and verification of patient insurance eligibility for services provided by The Cardiovascular Care Group. This position plays a critical role in supporting the revenue cycle by maintaining billing accuracy, minimizing claim denials, and ensuring patient insurance information is verified prior to services whenever possible. The ideal candidate demonstrates strong attention to detail, knowledge of medical billing processes, excellent customer service skills, and the ability to work effectively in a fast-paced healthcare environment.

Essential Duties and Responsibilities:

Charge Entry Functions

• Enter professional and ancillary charges accurately and efficiently into the practice management system.
• Review charge tickets, encounter forms, procedure reports, and supporting documentation for completeness and accuracy.
• Verify appropriate CPT, ICD-10, and HCPCS codes are documented and submitted in accordance with payer and compliance requirements.
• Identify and resolve charge discrepancies by communicating with providers, clinical staff, and billing personnel.
• Ensure daily charge entry is completed within established productivity and quality standards.
• Monitor work queues and reconcile charges to ensure all services rendered are captured and billed appropriately.
• Assist with corrections, adjustments, and rebilling as needed.

Insurance Eligibility Verification

• Verify patient insurance coverage, benefits, and eligibility prior to scheduled services.
• Confirm policy effective dates, copayments, coinsurance, deductibles, referral requirements, and authorization requirements.
• Document eligibility findings accurately within the electronic medical record (EMR) and practice management systems.
• Communicate coverage issues and financial responsibilities to appropriate staff and patients as necessary.
• Coordinate with scheduling and front-desk teams to resolve insurance-related issues before appointments.
• Identify secondary insurance coverage and ensure accurate coordination of benefits information.

Revenue Cycle Support

• Assist in reducing claim denials by ensuring accurate patient demographics, insurance information, and charge capture.
• Support denial management efforts by researching eligibility and registration-related claim rejections.
• Maintain compliance with federal, state, HIPAA, and organizational policies regarding patient information.
• Participate in audits and quality assurance reviews to improve billing accuracy and workflow efficiency.
• Maintain current knowledge of insurance payer policies and reimbursement guidelines.

Qualifications:

Education

• High school diploma or equivalent required.
• Associate degree in healthcare administration, medical billing, coding, or related field preferred.

Experience

• Minimum of 2 years of experience in medical billing, charge entry, insurance verification, or revenue cycle operations preferred.
• Experience in a specialty physician practice, cardiovascular practice, or multispecialty medical group strongly preferred.
• Familiarity with APRIMA EMR and practice management systems.

Knowledge, Skills, and Abilities

• Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.
• Understanding of insurance plans, payer requirements, and eligibility verification processes.
• Strong attention to detail and data-entry accuracy.
• Excellent organizational and time-management skills.
• Ability to prioritize multiple tasks and meet deadlines.
• Strong analytical and problem-solving abilities.
• Effective written and verbal communication skills.
• Proficiency with Microsoft Office applications, including Excel and Outlook.
• Ability to maintain confidentiality and adhere to HIPAA regulations.

Success Factors

The successful Charge Entry and Eligibility Specialist will:

• Maintain high charge-entry accuracy rates.
• Verify insurance eligibility in a timely manner to support patient access and reimbursement.
• Help reduce claim denials related to registration, insurance, and billing errors.
• Demonstrate professionalism, teamwork, and a commitment to exceptional patient service.
• Contribute to the organization's overall revenue cycle performance and financial success.

The Cardiovascular Care Group Mission

The Charge Entry and Eligibility Specialist supports The Cardiovascular Care Group's commitment to delivering exceptional vascular care by ensuring accurate billing, efficient revenue cycle operations, and a positive patient financial experience.

Benefits:

• Excellent work/life balance - Day shift, no evenings, weekends or holidays
• Medical (100% paid by the group for Employee Only coverage with the Cigna Bronze plan). 
• Dental – three plans to choose from Delta Dental and Cigna.
• Vision – two plans to choose from Delta VSP.
• Health Savings Account and Flexible Spending Accounts (Healthcare, Dependent Care, Transit and Parking) through Upswing.
• Life Insurance – $25,000 Paid by the group with the option to enroll in additional Voluntary Life Insurance coverage.
• Short-Term Disability and Long-Term Disability through New York Life with the option to enroll in additional voluntary coverage.
• Ancillary optional benefits – Accident, Critical Illness and Hospital Indemnity through New York Life. 
• Paid Time Off 
• Holiday Pay 
• Paid Jury Duty – 1 day of full pay. 
• Employee Assistance Programs through RWJBH and Cigna.
• 401k Employer Contributions – upon eligibility, group contributes 3% 
• Working Advantage and Life Mart Employee Discounts.
• Holiday Party, Employee Appreciation Days, Ice Cream Socials, various Fundraisers and Contests (receive prizes!) – Lots of employee engagement.