Specialist Charge Revenue Integrity - (Remote

Employment Type:

Full time

Day Shift

Purpose

Work Remote Position

(Pay Range: $25.0209-$37.5313)

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

Note:

"patients" refers to patients, clients, residents, participants, customers, members

Our Trinity Health Culture:
Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus

• Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
• Responsible for distribution of analytical reports.

Process Focus

• Utilizes multiple system applications to perform analysis, create reports & develop educational materials.
• Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis

• Research & compiles information to support ad-hoc operational projects & initiatives.
• Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Responsible for ensuring accurate CPT/HCPCS documentation for the patient billing process and educating 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.

Review's chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges.

Verifies charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers.

Review's documentation, abstracts data and ensure 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, & DNFB.

Provides "at-elbow support" to ancillary departments including but not limited to; ensuring supply charges are appropriate captured (may include implants), identify duplicate charges and initiate appropriate communications when there are documentation and/or charge deficiencies or charge errors.

Performs charge entry, charge approvals, and/or quality charge reviews; including but not limited to, 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 need for accurate and complete documentation to ensure revenue optimization and integrity.

Associate's degree in healthcare, business administration, finance, accounting, or related field or equivalent experience considered in lieu of degree.

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.

Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging processes & audits, & clinical billing

Working knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to charge documentation, capture & billing is required.

Knowledge of charge capture, reconciliation, error management operations & overall revenue cycle operations…