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AI Summary
The specialist is responsible for reviewing and validating daily charges against documentation within the NextGen platform, utilizing RCx Rules to ensure accuracy and compliance before claim submission. This role also involves extensive collaboration with providers and coding teams to resolve inconsistencies, prevent revenue loss, and support system workflows.
Revenue Cycle Management (RCM) Charge Capture Specialist
Position Summary:
The RCM Charge Capture Specialist at US Eye plays a critical role in ensuring accurate and compliant charge capture across a network of multi-specialty practices. This position is responsible for reviewing and validating charges, aligning documentation and coding, investigating denials, and supporting system workflows within the NextGen platform. The specialist collaborates extensively with providers, coding, and operations teams to identify and resolve charge inconsistencies, improve documentation, and prevent revenue loss. Additional responsibilities include performance monitoring, reporting, education, and participation in process improvement initiatives.
ESSENTIAL JOB FUNCTIONS:
Charge Review, Validation & Automation Oversight
Review daily and historical charges to ensure all billable services, procedures, and supplies are accurately captured in NextGen.
Utilize RCx Rules to proactively identify charge inconsistencies, missing charges, invalid modifiers, and coding risks prior to claim submission.
Validate charges against clinical documentation, operative notes, and encounter details.
Investigate and resolve RCx Rules edits and exceptions, escalating issues when systemic changes are required.
Ensure correct modifiers, laterality, units, and place-of-service selections are applied before claims are released.
Documentation & Coding Alignment
Partner with providers and clinical teams to ensure documentation supports services billed in NextGen.
Identify documentation gaps flagged by RCx Rules or internal audits that may result in denials or compliance risk.
Collaborate with coding teams to resolve discrepancies between charge capture, coding, and payer requirements.
Support appropriate CPT, HCPCS, and ICD-10 code usage in alignment with payer, regulatory, and specialty-specific guidelines.
Denial Prevention & Root Cause Analysis
Participate in root cause analysis for charge-related denials and claim rejections.
Provide actionable feedback to RCM, Operations, and Clinical teams to prevent recurrence.
Assist in refining RCx Rules logic based on denial outcomes and payer behavior.
OTHER DUTIES AND RESPONSIBILITIES:
System & Workflow Management
Maintain charge integrity within NextGen, including charge entry workflows, templates, and edits.
Support testing and validation of RCx Rules and NextGen updates impacting charge capture.
Collaborate with IT, Practice Systems, and RCM leadership during system upgrades, enhancements, or workflow changes.
Ensure alignment between RCx Rules automation and NextGen operational processes.
Reporting & Performance Monitoring
Track charge capture accuracy, RCx Rules exception volumes, and resolution outcomes.
Develop and maintain reporting to provide leadership visibility into charge-related trends and financial impact.
Support internal audits, payer audits, and compliance reviews related to charge capture and billing accuracy.
Education, Training & Process Improvement
Educate providers, technicians, and clinic staff on charge capture best practices and documentation standards.
Assist in the development and maintenance of SOPs related to charge capture, RCx Rules usage, and NextGen workflows.
Participate in cross-functional initiatives to improve front-end, clinical, and billing processes affecting revenue integrity.
COMPETENCIES:
2–4 years of experience in revenue cycle management, charge capture, coding, or medical billing.
Strong working knowledge of CPT, HCPCS, ICD-10, modifiers, and payer billing requirements.
Hands-on experience with NextGen or similar EHR/PM systems.
Ability to interpret and act on system edits and automation rules (RCx Rules or comparable tools).
Strong analytical, problem-solving, and communication skills.
Preferred Qualifications
CPC, CCS, or related coding certification.
Ophthalmology or specialty practice experience.
Experience with RCx Rules, claim scrubbers, or automation platforms.
Familiarity with Waystar clearinghouse workflows and denial management.
Audit and compliance experience.
POSITION TYPE AND EXPECTED HOURS OF WORK:
This is a full-time remote position
Location: Remote in AL, FL, GA, IL, IN, MI, MO, NC, OH, PA, SC, TN, TX, VA
BENEFITS:
401(K) Company Match
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Position Summary:
The RCM Charge Capture Specialist at US Eye plays a critical role in ensuring accurate and compliant charge capture across a network of multi-specialty practices. This position is responsible for reviewing and validating charges, aligning documentation and coding, investigating denials, and supporting system workflows within the NextGen platform. The specialist collaborates extensively with providers, coding, and operations teams to identify and resolve charge inconsistencies, improve documentation, and prevent revenue loss. Additional responsibilities include performance monitoring, reporting, education, and participation in process improvement initiatives.
ESSENTIAL JOB FUNCTIONS:
Charge Review, Validation & Automation Oversight
Review daily and historical charges to ensure all billable services, procedures, and supplies are accurately captured in NextGen.
Utilize RCx Rules to proactively identify charge inconsistencies, missing charges, invalid modifiers, and coding risks prior to claim submission.
Validate charges against clinical documentation, operative notes, and encounter details.
Investigate and resolve RCx Rules edits and exceptions, escalating issues when systemic changes are required.
Ensure correct modifiers, laterality, units, and place-of-service selections are applied before claims are released.
Documentation & Coding Alignment
Partner with providers and clinical teams to ensure documentation supports services billed in NextGen.
Identify documentation gaps flagged by RCx Rules or internal audits that may result in denials or compliance risk.
Collaborate with coding teams to resolve discrepancies between charge capture, coding, and payer requirements.
Support appropriate CPT, HCPCS, and ICD-10 code usage in alignment with payer, regulatory, and specialty-specific guidelines.
Denial Prevention & Root Cause Analysis
Participate in root cause analysis for charge-related denials and claim rejections.
Provide actionable feedback to RCM, Operations, and Clinical teams to prevent recurrence.
Assist in refining RCx Rules logic based on denial outcomes and payer behavior.
OTHER DUTIES AND RESPONSIBILITIES:
System & Workflow Management
Maintain charge integrity within NextGen, including charge entry workflows, templates, and edits.
Support testing and validation of RCx Rules and NextGen updates impacting charge capture.
Collaborate with IT, Practice Systems, and RCM leadership during system upgrades, enhancements, or workflow changes.
Ensure alignment between RCx Rules automation and NextGen operational processes.
Reporting & Performance Monitoring
Track charge capture accuracy, RCx Rules exception volumes, and resolution outcomes.
Develop and maintain reporting to provide leadership visibility into charge-related trends and financial impact.
Support internal audits, payer audits, and compliance reviews related to charge capture and billing accuracy.
Education, Training & Process Improvement
Educate providers, technicians, and clinic staff on charge capture best practices and documentation standards.
Assist in the development and maintenance of SOPs related to charge capture, RCx Rules usage, and NextGen workflows.
Participate in cross-functional initiatives to improve front-end, clinical, and billing processes affecting revenue integrity.
COMPETENCIES:
2–4 years of experience in revenue cycle management, charge capture, coding, or medical billing.
Strong working knowledge of CPT, HCPCS, ICD-10, modifiers, and payer billing requirements.
Hands-on experience with NextGen or similar EHR/PM systems.
Ability to interpret and act on system edits and automation rules (RCx Rules or comparable tools).
Strong analytical, problem-solving, and communication skills.
Preferred Qualifications
CPC, CCS, or related coding certification.
Ophthalmology or specialty practice experience.
Experience with RCx Rules, claim scrubbers, or automation platforms.
Familiarity with Waystar clearinghouse workflows and denial management.
Audit and compliance experience.
POSITION TYPE AND EXPECTED HOURS OF WORK:
This is a full-time remote position
Location: Remote in AL, FL, GA, IL, IN, MI, MO, NC, OH, PA, SC, TN, TX, VA
BENEFITS:
401(K) Company Match
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
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