Specialist Charge Revenue Integrity - (Remote)

Employment Type: Full time, Day Shift

About the role

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses 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 a project or project team by applying industry experience and specialized knowledge.

Note: “patients” refers to patients, clients, residents, participants, customers, members.

Responsibilities

• Researches, collects, and analyzes information. Identifies opportunities, develops solutions, and leads through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency and patient experience.
• Responsible for distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports, and develop educational materials.
• Incorporates basic knowledge of Trinity Health policies, practices, and processes to ensure quality, confidentiality, and safety are prioritized.
• Demonstrates knowledge of departmental processes and procedures and ability to readily acquire new knowledge.
• Researches and compiles information to support ad-hoc operational projects and initiatives.
• Synthesizes and analyzes data, providing detailed summaries including graphical data presentations illustrating trends and recommending practical options or solutions while considering the impact on business strategy and supporting leadership decision making.
• Leverages program and operational data and measurements to define and demonstrate progress, ROI, and impacts.
• Ensures accurate CPT/HCPCS documentation for the patient billing process and educates colleagues and ancillary departments in accurately documenting services performed and using the appropriate codes representing those services.
• Responsible for charge capture in Revenue Integrity assigned areas.
• Reviews charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret, validate, and/or extract all charges.
• Verifies charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers.
• Reviews documentation, abstracts data, and ensures charges/coding are in alignment within AMA and Medicare coding guidelines.
• Performs coding functions, including CPT, ICD-10 assignment, documentation review, and claim denial review.
• Responsible for working the pre-bill edits within key metrics, including but not limited to OCE/CCI, and DNFB.
• Provides “at-elbow support” to ancillary departments including ensuring supply charges are appropriately captured (may include implants), identifying duplicate charges, and initiating appropriate communications when there are documentation and/or charge deficiencies or errors.
• Performs charge entry, charge approvals, and/or quality charge reviews; including appending modifiers and checking clinical documentation.
• Provides feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity.
• Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice.
• Educates clinical staff on the need for accurate and complete documentation to ensure revenue optimization and integrity.
• Maintains a working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity and Compliance Program and Code of Conduct, as well as other policies, procedures, and guidelines to ensure adherence in a manner that reflects honest, ethical, and professional behavior and safe work practices.

Requirements

• Associate’s degree in healthcare, business administration, finance, accounting, or related field or equivalent experience considered in lieu of degree.
• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, AAPC, or other coding credentials required.
• Minimum three (3) years of relevant coding and charge control work experience in a hospital and/or Physician Practice environment and 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.

Skills

• Licensure/Certification: CDC (Healthcare Compliance Certification) preferred.
• CHRI certification/membership strongly preferred.
• Knowledge of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre-bill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).
• Knowledge of clinical documentation improvement processes strongly preferred.

Pay

Pay Range: $25.0209-$37.5313 per hour

Physical & Mental Requirements

• Exposure to conditions which may be considered unpleasant to sight, touch, sound, and/or smell: Occasional
• Exposure to fumes, odors, dusts, mists, and gases, biohazards/hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.): Occasional
• Exposure to or subject to noise, infectious waste, diseases, and conditions: Occasional
• Exposure to interruptions, shifting priorities, and stressful situations: Frequent
• Ability to follow tasks through to completion, understand and relate to complex ideas/concepts, remember multiple tasks and regimens over long periods of time, and work on concurrent tasks/projects: Frequent
• Ability to read small print, hear sounds and voice/speech patterns, give/receive instructions and other verbal communications (in-person and/or over the phone/computer/device/equipment assigned) with some background noise: Frequent
• Perform manual dexterity activities and/or grasping/handling: Frequent
• Ability to climb, kneel, crouch, and/or operate foot controls: Occasional
• Use a computer/other technology: Frequent
• Sit with the ability to vary/adjust physical position or activity: Frequent
• Maintain a safe working environment and use available personal protective equipment (PPE): Continuous
• Comply with Trinity Health’s Code of Conduct, policies, procedures, and guidelines: Continuous
• Ability to provide assistance in the event of an emergency: Occasional
• Perform activities that require standing/walking with the ability to vary/adjust physical position or activity: Occasional (Direct Healthcare Services), Frequent (Indirect Healthcare/Support Services)
• Lift a maximum of 30 pounds unassisted: Occasional
• Use upper and lower extremities, engage in bending/stooping/reaching and pushing/pulling: Occasional
• Work indoors (subject to travel requirements) under temperature-controlled and well-lit conditions: Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal and external environmental conditions: Continuous (Direct Healthcare Services), Occasional (Indirect Healthcare/Support Services)
• Perform work that involves physical efforts (e.g., transporting, moving, positioning, and/or ambulating patients): Occasional (Direct Healthcare Services)
• Experience long periods of walking/standing/stooping/bending/pulling and/or pushing: Occasional (Indirect Healthcare/Support Services)
• Encounter a clinical/patient-facing/hands-on interactive work environment: Occasional (Indirect Healthcare/Support Services)
• Work outdoors with variable external environmental conditions: Occasional (Indirect Healthcare/Support Services)