The Charge Review Specialist serves as the primary reviewer of all pre and post-transplant and clinical research related charges organization-wide. The position coordinates and completes line item charge review of patient encounters in VCUHS charge systems to ensure the accuracy and completeness of charges captured for insurance and patient billing of hospital services.
Using electronic platforms, the position reviews all charges, both inpatient and outpatient, that are incurred on "flagged" accounts daily to ensure that they meet proper classification and payer account eligibility requirements, determines charges/bills that are eligible for release, and directs charges to the appropriate client account for all payers. The position provides specialized support to transplant and clinical research staff, practice site compliance, and revenue cycle personnel regarding billing.
Licensure, Certification, or Registration Requirements for Hire:
One of the following Certifications is Preferred:
Certified Professional Coder (CPC) or
Certified Outpatient Coder (COC), formerly CPC-H or,
Certified Inpatient Coder (CIC) by the American Academy of Procedural Coders or,
Certified Coding Specialist (CCS), or
Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA)
Licensure, Certification, or Registration Requirements for continued employment: N/A
Experience REQUIRED:
Minimum of two (2) years of work experience in medical billing;
Minimum of three (3) years of work experience in a customer-related service position;
Working knowledge of medical terminology and medical procedures;
Previous experience using a personal computer and various software applications, including Microsoft Office Word and Excel, e-mail, etc
Experience PREFERRED
Three (3) years of work experience in medical environment reviewing patients records with emphasis on finance/billing;
Previous experience with protocols and/or financial/budgeting for clinical trials;
Previous experience in medical coding with emphasis on transplant
Previous patient records review and abstraction experience;
Previous experience in medical coding; and
Three (3) years of work experience in a team environment.
Education/training REQUIRED:
High School Diploma or equivalent
Education/training PREFERRED:
Bachelor's degree in Finance, Accounting, Business/Health Administration or a related field from an accredited program or Bachelor's Degree in Nursing
Independent action(s) required:
Detail-oriented and self-motivated team player
Daily work is handled independently
Direction, advice, guidance are sought from management, Clinicians as necessary, and other applicable resources
Meets deadlines in ever changing work environment
Supervisory responsibilities (if applicable): N/A
Additional position requirements:
Generally works day shift, Monday through Friday, but may require flexibility for special projects
Age Specific groups served: Adult
Physical Requirements (includes use of assistance devices as appropriate):
Physical Lifting less than 20 lbs.
Activities: Prolonged sitting, Repetitive motion
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking
Emotional: Fast pace environment, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change Add under job profile: "In addition to performing charge reviewer duties, this position uniquely encompasses key prior authorization tasks, including full responsibility for both prior and retro authorization processes. The role involves filing appeals for denied prior authorizations, ensuring timely resolution, and supporting reimbursement efforts." Add under job description: "Previous experience with prior authorizations and appeals." EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
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Virginia Commonwealth University Health Systems
Apr 01, 2025