Regional Billing Specialist - Ambulatory Charge Capture Services

Regional Billing Specialist opportunity in the Ambulatory Charge Capture Services department.  The ideal candidate is detail-oriented with experience in charge capture and reconciliation in a physician practice. They have strong knowledge of CPT, ICD-10-CM, and HCPCS coding, and excel at resolving discrepancies, reviewing charges, and collaborating with providers. They thrive in fast-paced, multi-specialty settings and prioritize accuracy and compliance. Epic and coding experience; coding certification is a plus.

SUMMARY

This position is responsible for the accurate and timely charge capture and reconciliation of both professional and technical charges across complex, multi-specialty oncology service lines. The role requires strong analytical skills to review charges and clinical documentation, ensuring alignment with CPT/HCPCS coding standards and industry guidelines to support revenue integrity. Effective communication and customer service skills are essential, as the position works closely with management, providers, and clinical support teams to resolve discrepancies and promote accurate documentation and charge practices.

JOB SPECIFIC COMPETENCIES

Charge Capture of Professional and Technical/Facility Charges

Ensure timely and accurate daily charge capture submission for multi-specialty professional and technical (hospital) services across assigned centers, in compliance with institutional billing and charge submission policies.

Review and analyze complex professional and facility revenue mapping, billing, and documentation for accuracy; escalate discrepancies to management and provide education to providers and clinical staff as needed.

Monitor all charge entry processes for completeness and accuracy. Investigate compliance issues, identify improvement opportunities, and collaborate with management to deliver training and implement corrective measures.

Stay current with industry standards and institutional billing compliance guidelines, including CPT-4, ICD-10-CM, and HCPCS code updates.

Manage open encounter workflows:

Professional Encounters: Review, track, and communicate outstanding encounters to providers; summarize status for center management.

Technical Encounters: Monitor daily and coordinate with nursing staff to close open encounters and capture all charges.

Initiate and implement charge corrections, including researching root causes and updating the billing system to ensure claims are compliant and accurately submitted.

Notify management of any systemic or recurring issues affecting charge capture timeliness or compliance.

Support Charge Description Master (CDM) maintenance and analysis, ensuring correct supply charge entries and identifying new billable items.

Adhere to standardized workflows and productivity metrics as established by department and institutional policies.

Maintain professional and effective communication with providers, clinical support teams, and leadership.

Provide training and support to providers, billing staff, and clinical teams; cross-train and assist across centers as needed.

Charge Reconciliation of Professional and Technical/Facility Charges

Reconcile charges daily to identify discrepancies or omissions and ensure timely, accurate billing for services rendered.

Utilize designated reconciliation tools and work queues, including reconciliation reports and EMR documentation, to verify compliant charge submission.

Communicate proactively with providers and clinical staff to resolve missing or incomplete charges.

Identify and escalate inaccuracies in charge submission and revenue mapping, collaborating with management to implement corrective actions.

Maintain consistent performance standards aligned with departmental productivity and workflow guidelines.

Provide cross-functional training and support for clinical and billing staff; work across centers as required.

Professional Charge Capture and Reconciliation for Outside Facility Rounding Services

Oversee charge capture, entry, and reconciliation processes for professional services provided by Houston Area Location Faculty at outside facilities.

Obtain and manage access to external EMRs for accurate charge documentation and medical record retrieval.

Verify and validate patient registration, including insurance and demographic data, to ensure complete and accurate billing.

Obtain financial information needed to determine financial eligibility according to MD Anderson managed care contracts.

Retrieve, review, and abstract external medical records to support submitted charges, ensuring accurate assignment of CPT and ICD-10-CM codes.

Project Management and Reporting

Support ongoing billing compliance monitoring and deliver educational sessions for staff and clinical team.

Contribute to CDM analysis and maintenance to ensure correct supply charge capture and identification of new chargeable items.

Collect, analyze, and summarize data for special projects and reporting purposes.

Develop and oversee charge reconciliation and audit workflows for professional and technical services to ensure completeness and accuracy of billing.

Identify opportunities for process improvement; escalate issues and implement corrective actions in collaboration with management.

Perform additional duties and responsibilities as assigned.

Other duties as assigned