Charge Capture and Billing Specialist

Position Title: Charge Capture & Billing Specialist
Department: Revenue Cycle
Reports To: Director of Charge Capture and Billing
Location: On site 

Position Summary

The Charge Capture & Billing Specialist is responsible for overseeing all activities related to professional and/or facility charge capture, medical coding accuracy, billing workflows, and reimbursement optimization. This role ensures compliance with applicable regulations, maintains revenue integrity, and drives operational efficiency across the revenue cycle. The Specialist provides leadership to charge capture and billing teams, partners with clinical departments, and ensures timely, accurate claim submission.

Key Responsibilities:

Charge Capture Oversight

Lead and manage the daily operations of charge capture workflows to ensure all services are accurately recorded and billed.

Develop processes to reduce leakage, prevent missing or incomplete charges, and improve overall charge accuracy.

Collaborate with clinical departments to ensure documentation supports compliant charge capture.

Monitor edits, charge review queues, and billing worklists; resolve issues promptly.

Billing & Coding Management

Oversee billing processes to ensure timely claims submission and adherence to payer guidelines.

Review coding accuracy, ensuring alignment with CPT, ICD 10, HCPCS, and payer policy requirements.

Serve as a subject matter expert on billing compliance, coding rules, and reimbursement methodologies (e.g., RVUs, APCs, RBRVS).

Partner with auditors and compliance teams to mitigate risk and implement corrective action plans.

Revenue Integrity & Compliance

Ensure all billing practices comply with state, federal, and payer regulations, including Medicare/Medicaid.

Monitor trends in denials, rejections, and underpayments; implement process improvements to reduce errors.

Develop policies and procedures for charge capture, coding, and billing operations.

Drive adoption of internal controls to ensure data integrity and compliance with organizational guidelines.

Leadership & Team Development

Manage, mentor, and evaluate billing/charge capture staff.

Provide ongoing training related to coding updates, compliance changes, and system enhancements.

Collaborate cross functionally with clinical leaders, IT, compliance, and finance.

Reporting & Analytics

Develop and distribute reports on charge capture performance, coding accuracy, billing productivity, and key revenue metrics.

Analyze trends and proactively identify revenue opportunities or operational issues.

Support leadership with strategic project planning and revenue cycle initiatives.

Required Qualifications

Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or related field (or equivalent experience).

Certified Professional Coder (CPC) required.

Minimum 5+ years of experience in medical billing, professional/facility coding, or charge capture.

Minimum 3 years in a supervisory or managerial role within the revenue cycle.

Strong working knowledge of CPT, ICD 10, HCPCS, and payer reimbursement rules.

Experience with electronic health records (EHR) and billing 

Preferred Qualifications

Additional certifications: CCS, CPMA, CRC, or RHIA/RHIT.

Experience in both professional and facility billing environments.

Demonstrated success in process improvement and revenue optimization initiatives.

Core Competencies

Strong understanding of revenue cycle operations and compliance.

Excellent analytical and problem-solving skills.

Ability to communicate professionally with clinicians, executives, and staff.

Leadership capability with skills in coaching, training, and change management.

High attention to detail and exceptional organizational skills.

Physical & Work Requirements

Ability to work in a fast-paced, team-oriented environment.

Ability to sit at a computer terminal for an extended period. 

Moderate noise (i.e., phone calls, online meetings, and computer audio). 

While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard. 

Specific vision abilities required by this job include close vision requirements due to computer work. 

Regular, predictable attendance is required. 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing [email protected].