Specialist Charge Revenue Integrity (Remote)

Employment Type: Full time, Day Shift

Pay Range: $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 assist 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.

Note: “patients” refers to patients, clients, residents, participants, customers, and 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 knowledge of Trinity Health policies, practices, and processes to ensure quality, confidentiality, and safety.
• Demonstrates knowledge of departmental processes and procedures and ability to acquire new knowledge quickly.
• Researches and compiles information to support ad-hoc operational projects and initiatives.
• Synthesizes and analyzes data, providing detailed summaries including graphical presentations illustrating trends and recommending practical options or solutions while considering business strategy impacts.
• Leverages program and operational data to define and demonstrate progress, ROI, and impacts.
• Maintains working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity & 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 accurate documentation and appropriate coding.
• Responsible for charge capture in Revenue Integrity assigned areas.
• Reviews charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes to interpret, validate, and/or extract all charges.
• Verifies charges are captured on the correct patient, encounter, date of service, and with required modifiers.
• Reviews documentation, abstracts data, and ensures charges/coding align with AMA and Medicare coding guidelines.
• Performs coding functions, including CPT, ICD-10 assignment, documentation review, and claim denial review.
• Works pre-bill edits within key metrics, including OCE/CCI and DNFB.
• Provides “at-elbow support” to ancillary departments to ensure appropriate charge capture (including implants), identify duplicate charges, and initiate communications for documentation or charge deficiencies.
• Performs charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation.
• Provides feedback to intra-departmental Revenue Integrity colleagues on areas of opportunity.
• Responsible for coding and/or validation of charges for complex service lines, with 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 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.
• 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

• 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.
• Knowledge of 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.

Physical & Mental Requirements

• Exposure to unpleasant conditions (sight, touch, sound, and/or smell): Occasional
• Exposure to fumes, odors, dusts, mists, gases, biohazards, and hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects): Occasional
• Exposure 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 complex ideas, remember multiple tasks over long periods, and work on concurrent tasks: Frequent
• Ability to read small print, hear sounds and speech patterns, and communicate verbally (in-person, phone, or other devices) 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 or other technology: Frequent
• Sit with the ability to vary/adjust physical position or activity: Frequent
• Maintain a safe working environment and use 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), 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 under temperature-controlled and well-lit conditions: Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites with variable environmental conditions: Continuous (Direct Healthcare), Occasional (Indirect Healthcare/Support Services)
• Perform work involving physical efforts (e.g., transporting, moving, positioning, and/or ambulating patients): Occasional (Direct Healthcare)
• Experience long periods of walking/standing/stooping/bending/pulling/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)

Average Workday Activity: Occasional - 1%–33%, Frequent - 34%–66%, Continuous - 67%–100%