RCM Charge Posting Specialist

Job Summary:

The RCM Charge Posting Specialist converts documented clinical activity into accurate, compliant, claim-ready charges for
clinic, ASC, laboratory, anesthesia, radiology, and assigned specialty services. The role is a control point between
documentation/coding and claim submission and is accountable for charge completeness, diagnosis linkage, modifiers,
payer requirements, work-queue resolution, and timely escalation.

Key Responsibilities:

1. Charge Capture, Validation, and Posting
Review encounter and procedure documentation for complete charge capture and sufficient support before posting;
query rather than infer when documentation is incomplete.
Validate date of service, place of service, rendering/billing provider, referring provider when applicable, facility, units,
fee schedule, CPT/HCPCS, ICD-10-CM diagnosis linkage, modifiers, and payer sequence before claim creation.
Manually post and validate ASC, injection, advanced procedure, radiology, and newly implemented procedure charges
as assigned.
Reconcile expected encounters/procedures to posted charges so missing charges are identified, researched, and
cleared rather than simply omitted.
Follow approved coding and charge-entry rules. Do not independently select or change codes when the circumstance
requires a coder or provider query.
2. Claim Readiness and Front-End Denial Prevention
Review eCW edits, deficiency reports, claim procedure reports, claim-engine edits, clearinghouse rejections, eligibility
or authorization indicators, and other pre-bill exceptions.
Confirm payer-specific requirements affecting clean claims, including authorization, referral, provider enrollment,
timely filing, bundling/edit logic, laterality, units, modifiers, and place-of-service rules.
Resolve correctable front-end errors and route documentation, coding, authorization, eligibility, credentialing, or system
issues to the accountable owner with a due date.
Company expectation is generally charge submission within 48 hours of the encounter unless an approved hold or
documented dependency exists.
3. Audits, Reconciliation, and Continuous Improvement
Perform or support quarterly internal/external provider and charge audits and document findings, corrective actions,
and education.
Identify recurring documentation, coding, payer, insurance, authorization, or system patterns that create claim edits,
denials, compliance exposure, or revenue leakage.
Maintain procedure/payer job aids, approved billing rules, and escalation guides; communicate material rule changes to
internal teams.
RCM Operating Model | Internal Role + Third-Party Support | November 2026
Performance Standards and Suggested KPIs
Charge lag: target at least 95% of eligible charges entered/submitted within 48 hours; separately report approved holds.
Charge accuracy: target at least 98% on audited fields, with 100% expectation for patient/provider identity and material
compliance elements.
Unbilled/missing encounters: daily reconciliation with no unexplained aged encounter beyond the defined escalation
threshold.
First-pass/clearinghouse quality: monitor rejection rate attributable to charge-entry defects and trend by root cause,
facility, provider, employee, and vendor.

Qualifications:

College Graduate of any four-year course
At least 1-2 years of physician, ASC, or specialty billing/charge-entry experience, or an appropriate coding credential
with demonstrated claim knowledge.
Strong working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, diagnosis linkage, payer policies, claim
edits/rejections, medical terminology, and basic revenue-cycle workflow.
eClinicalWorks experience strongly preferred; proficiency with payer portals, clearinghouse tools, Excel, Outlook, and
electronic work queues.
CPC, CCS, CCA, CPB, or comparable credential preferred; pain management and ASC experience strongly preferred.