"Failed Claims Specialist"

Scope of Position

By working under the supervision of the direct manager, The Charge Capture Specialist is responsible for optimal and quality charge entry related to all inpatient and outpatient separately billable services. Conduct thorough review of the medical record to ensure that the clinical documentation supports all billed charges. Take an active role in identifying the discrepancies in nursing documentation and report findings to nurse managers. Follow up on all incomplete & inaccurate charges and makes corrections promptly. Establish a strong working relationship with the nursing, revenue, and administrative staff. Maintain a working knowledge of CPT coding guidelines and government rules and regulations. Review daily reports generated to check prior day's charges for accuracy. Help in educating the clinical staff on what is considered a billable service based on governmental regulations and guidelines. Take a role in maintaining charge capture policies and procedures manual and in training new staff. Abide by OSUWMC and the James policies, procedures, and code of conduct. Perform other duties as directed and assigned.

Position Summary

The Charge Capture Specialist is primarily responsible for charge capture for the various inpatient and outpatient departments affiliated with the James Cancer Center. This position contributes to the day to day operations of the nursing units and adheres to OSUMC and James policies and procedures, including the organization's compliance program. The Charge Capture Specialist utilizes Relationship-Based Care to guide professional practice and embraces the James's mission, values, and standards by providing positive customer relations and achieving goals consistent with Key Results Areas which includes endorsing the organization's compliance program, maintaining infection control standards and implementing patient safety protocols as necessary. In keeping with the James Nursing mission, vision, and value statements, participation in volunteer activities for the community and professional organizations is highly encouraged and supported.

Minimum Requirements

Per Classified Civil Svc Specs or equivalent combination of education and experience. Minimum requirement is high school diploma or general education degree (GED). Bachelor's degree in healthcare or healthcare related field and equivalent experience is preferred. Workable knowledge in medical terminology is required. Strong computer skills in areas of data mining and data analysis are desired. Coding certification is desired.