Specialist Charge Revenue Integrity (Cardiology) - (Remote)

Trinity Health•Livonia, MI

1d•$22 - $33•Remote

About The Position

This is a remote, full-time position focused on revenue integrity within Cardiology. The role utilizes specialized knowledge to support key organizational areas, employing data analysis, critical thinking, and problem-solving skills to aid colleagues and leadership in achieving strategic objectives. The Specialist acts as a peer influencer and may lead projects or teams, leveraging industry experience and specialized knowledge. The position involves researching, collecting, and analyzing information to identify opportunities, develop solutions, and drive them to resolution. Collaboration on performance improvement activities related to program efficiency and patient experience is expected, along with the distribution of analytical reports. The role requires utilizing multiple system applications for analysis, report creation, and educational material development, while incorporating knowledge of Trinity Health policies, practices, and processes to ensure quality, confidentiality, and safety. A working knowledge of applicable laws, regulations, and the Trinity Health Integrity & Compliance Program is essential.

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.
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 required.

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

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.
Reviews 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.
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, & 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.