Specialist Charge Revenue Integrity (Remote)

Trinity Health•Livonia, MI

1d•$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 position 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 to interpret and validate charges, verifying charges for accuracy, and ensuring charges/coding align with AMA and Medicare guidelines. The role also involves performing coding functions, working pre-bill edits, providing support to ancillary departments, performing charge entry and reviews, and educating clinical staff on documentation needs 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.
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

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.
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.
Review's 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.
Review's documentation, abstracts data and ensure 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.