Specialist Charge Revenue Integrity (Surgery Coding)

Trinity Health•Livonia, MI

5d•Remote

About The Position

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. 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.

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
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

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)

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
Charge capture in Revenue Integrity assigned areas
Reviewing charts 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
Ensuring supply charges are appropriately captured (may include implants)
Identifying duplicate charges
Initiating appropriate communications when there are documentation and/or charge deficiencies or charge errors
Performing charge entry, charge approvals, and/or quality charge reviews
Appending modifiers, and checking clinical documentation
Providing feedback to intra-departmental Revenue Integrity colleagues
Coding and/or validation of charges for more complex service lines
Educating clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity