Charge Specialist Revenue Integrity - (Remote)

Trinity Health•Livonia, MI

2d•$22 - $33•Remote

About The Position

This is a remote, full-time position for a Charge Specialist in Revenue Integrity. The role involves using specialized knowledge to support key organizational areas, leveraging data analysis, critical thinking, and problem-solving skills to achieve strategic objectives. The specialist will act as a peer influencer and may lead projects. The position requires a strong understanding of revenue cycle operations, including accurate CPT/HCPCS documentation, charge capture, and adherence to AMA and Medicare coding guidelines. The specialist will also educate colleagues and ancillary departments on proper documentation and coding practices, review charts, verify charges, and work pre-bill edits. Additionally, the role involves providing support to ancillary departments, performing charge entry and reviews, and handling more complex service lines.

Requirements

Associate’s degree in healthcare, business administration, finance, accounting, or related field, or equivalent experience.
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 & modifiers), charging processes & audits, & clinical billing.
Working knowledge of third-party payer rules & requirements.
Working knowledge of computer operations & electronic interfaces related to charge documentation, capture & billing.
Knowledge of charge capture, reconciliation, error management operations & overall revenue cycle operations.

Nice To Haves

Licensure/Certification: 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

Researches, collects, and analyzes information to identify opportunities and develop solutions.
Collaborates on performance improvement activities related to program efficiency and patient experience.
Distributes analytical reports.
Utilizes multiple system applications for analysis, report creation, and educational material development.
Researches and compiles information to support ad-hoc operational projects and initiatives.
Synthesizes and analyzes data, providing detailed summaries, graphical presentations, and recommendations.
Leverages program and operational data to define and demonstrate progress, ROI, and impacts.
Ensures accurate CPT/HCPCS documentation for patient billing and educates colleagues on accurate service documentation and coding.
Responsible for charge capture in assigned Revenue Integrity areas.
Reviews charts (nursing notes, physician orders, progress notes, surgical/specialty notes) to interpret, validate, and extract charges.
Verifies charges for correct patient, encounter, date of service, and 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, ensuring supply charges are captured, identifying duplicate charges, and communicating documentation/charge deficiencies or errors.
Performs charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation.
Provides feedback to Revenue Integrity colleagues on areas of opportunity.
Codes and/or validates charges for more complex service lines and advanced surgical or specialty coding.
Educates clinical staff on the need for accurate and complete documentation for revenue optimization and integrity.