Specialist Charge Revenue Integrity (Surgery Coding) - Remote

Trinity Health•Livonia, MI

7d•$25 - $38•Remote

About The Position

This is a remote position that utilizes specialized knowledge to support key areas of the organization related to an area of expertise. The role uses data, research analysis, critical thinking, and problem-solving skills to support colleagues and leadership in achieving the organization’s strategic objectives. The Specialist serves as a peer influencer and may direct a project or project team by applying industry experience and specialized knowledge. The role is 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. This includes charge capture in Revenue Integrity assigned areas, reviewing charts thoroughly to interpret and validate charges, verifying charges captured on the correct patient, encounter, and date of service with any required modifiers. The Specialist will review documentation, abstract data, and ensure charges/coding are in alignment with AMA and Medicare coding guidelines. The role also involves performing coding functions, working pre-bill edits, providing support to ancillary departments, performing charge entry/approvals/reviews, and educating clinical staff on documentation needs for revenue optimization and integrity. This position requires advanced proficiency in surgical or specialty coding practice.

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.
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.
Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects.
Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise.
Perform manual dexterity activities & / or grasping / handling.
Use a computer / other technology.
Sit with the ability to vary / adjust physical position or activity.
Maintain a safe working environment & use available personal protective equipment (PPE).
Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines.
Ability to provide assistance in the event of an emergency.
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.
Lift a maximum of 30 pounds unassisted.
Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling.
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.
Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.
Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients).
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.
Lift a maximum of 30 pounds unassisted.
Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing.
Encounter a clinical / patient facing / hands on interactive work environment.
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.

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.
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.
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.
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.
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.