Charge Specialist Revenue Integrity - (Remote)

Trinity Health•Livonia, MI

1d•Remote

About The Position

This is a remote, full-time position with a day shift. The Charge Specialist Revenue Integrity uses specialized knowledge to support key areas of the organization, leveraging data, research, analysis, critical thinking, and problem-solving skills to assist colleagues and leadership in achieving strategic objectives. This role serves as a peer influencer and may direct projects by applying industry experience and specialized knowledge. The position is responsible for ensuring accurate CPT/HCPCS documentation for patient billing, educating colleagues on accurate service documentation and appropriate coding, and performing charge capture in assigned Revenue Integrity areas. This involves reviewing charts, validating charges, ensuring alignment with AMA and Medicare guidelines, performing coding functions (CPT, ICD-10), reviewing claim denials, and working pre-bill edits. The specialist also provides support to ancillary departments, identifies duplicate charges, and communicates deficiencies or errors. They perform charge entry, approvals, and quality reviews, including appending modifiers and checking clinical documentation. Feedback is provided to intra-departmental colleagues, and the role involves coding and validating charges for complex service lines, requiring advanced proficiency in surgical or specialty coding. Additionally, the specialist educates clinical staff on the importance of accurate and complete documentation for 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.
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 & 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 required.

Nice To Haves

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

Responsibilities

Ensuring accurate CPT/HCPCS documentation for the patient billing process.
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.
Reviewing charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges.
Verifying charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers.
Reviewing documentation, abstracting data and ensuring charges/coding are in alignment within AMA and Medicare coding guidelines.
Performing coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review.
Working the pre-bill edits within key metrics, including but not limited to OCE/CCI, & DNFB.
Providing “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.
Performing charge entry, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation.
Providing feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity.
Coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice.
Educating clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity.