Specialist Charge Revenue Integrity - (Remote)

This is a full-time, remote position with a pay range of $25.0209–$37.5313 per hour.

About the Role

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Applies data, research analysis, critical thinking, and problem-solving skills to support colleagues and leadership in achieving the organization’s strategic objectives. Serves as a peer influencer and may direct projects or project teams by leveraging industry experience and specialized knowledge.

Responsibilities

• Researches, collects, and analyzes information to identify opportunities, develop solutions, and lead through resolution.
• Collaborates on performance improvement activities driven by program efficiency and patient experience outcomes.
• Distributes analytical reports and utilizes multiple system applications to perform analysis, create reports, and develop educational materials.
• Ensures quality, confidentiality, and safety by incorporating knowledge of Trinity Health policies, practices, and processes.
• Researches and compiles information to support ad-hoc operational projects and initiatives.
• Synthesizes and analyzes data, providing detailed summaries, graphical presentations, and practical recommendations to support leadership decision-making.
• Leverages program and operational data to define and demonstrate progress, ROI, and impacts.
• Maintains working knowledge of applicable federal, state, and local laws, Trinity Health’s Integrity and Compliance Program, Code of Conduct, and other policies to ensure adherence.
• Ensures accurate CPT/HCPCS documentation for the patient billing process and educates colleagues and ancillary departments on proper documentation and coding.
• Responsible for charge capture in assigned Revenue Integrity areas, reviewing charts (including nursing notes, physician orders, progress notes, and surgical/specialty notes) to validate and extract charges.
• Verifies charges are captured for the correct patient, encounter, date of service, and with required modifiers.
• Reviews documentation, abstracts data, and ensures charges and coding align with AMA and Medicare guidelines.
• Performs coding functions, including CPT, ICD-10 assignment, documentation review, and claim denial review.
• Works pre-bill edits within key metrics, such as OCE/CCI and DNFB.
• Provides "at-elbow support" to ancillary departments, ensuring appropriate capture of supply charges (including implants), identifying duplicate charges, and initiating communications for documentation or charge deficiencies.
• Performs charge entry, approvals, and quality charge reviews, including appending modifiers and checking clinical documentation.
• Provides feedback to intra-departmental Revenue Integrity colleagues on areas of opportunity.
• Codes and validates charges for complex service lines, demonstrating advanced proficiency in surgical or specialty coding.
• Educates clinical staff on the need for accurate and complete documentation to ensure revenue optimization and integrity.

Requirements

• Associate’s degree in healthcare, business administration, finance, accounting, or a related field (or equivalent experience).
• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, AAPC, or other coding credentials required.
• Minimum of three (3) years of relevant coding and charge control work experience in a hospital and/or physician practice environment, with experience in revenue cycle, billing, coding, and/or patient financial services.
• Demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes, and modifiers), charging processes and audits, and clinical billing.
• Working knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing.
• Knowledge of charge capture, reconciliation, error management operations, and overall revenue cycle operations.

Preferred Qualifications

• CDC (Healthcare Compliance Certification) preferred.
• CHRI certification/membership strongly preferred.
• Knowledge of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures.
• Familiarity with pre-bill edits, including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Not Final Billed (DNFB).
• Knowledge of clinical documentation improvement processes.

Working Conditions

This role may involve exposure to conditions that could be considered unpleasant to sight, touch, sound, and/or smell, including occasional exposure to fumes, odors, dust, mists, gases, biohazards, mechanical/electrical hazards, chemicals, radiation, and sharp objects.

• Occasional exposure to noise, infectious waste, diseases, and conditions.
• Occasional interruptions, shifting priorities, and stressful situations.
• Frequent ability to follow tasks through to completion, understand complex ideas, remember multiple tasks, and work on concurrent projects.
• Frequent ability to read small print, hear sounds and speech patterns, and communicate instructions verbally (in-person or via phone/computer/device) with some background noise.
• Frequent manual dexterity activities, grasping, handling, climbing, kneeling, crouching, and operating foot controls.
• Occasional use of a computer or other technology.
• Frequent sitting with the ability to vary physical position or activity.
• Frequent maintenance of a safe working environment and use of personal protective equipment (PPE).
• Continuous compliance with Trinity Health’s Code of Conduct, policies, procedures, and guidelines.
• Occasional ability to provide assistance in emergencies.
• For direct healthcare services: occasional standing/walking, lifting up to 30 pounds, bending/stooping/reaching, and pushing/pulling; occasional work indoors with temperature-controlled conditions; continuous travel to worksites with variable environmental conditions; occasional physical efforts such as transporting or moving patients.
• For indirect healthcare/support services: frequent standing/walking with the ability to vary physical position; occasional lifting up to 30 pounds; occasional long periods of walking, standing, stooping, bending, pulling, or pushing; occasional encounter with clinical or patient-facing environments; occasional work indoors with temperature-controlled conditions; continuous work outdoors with variable external conditions.

Activity frequency: Occasional (1%–33%), Frequent (34%–66%), Continuous (67%–100%).