Specialist Charge Revenue Integrity (Remote)

Trinity Health•Livonia, MI

6d•$25 - $38•Remote

About The Position

This remote, full-time day-shift position uses specialized knowledge, research, data analysis, critical thinking, and problem-solving to support organizational objectives. The Specialist serves as a peer influencer and may direct projects or project teams. The role supports revenue integrity by ensuring accurate charge capture and CPT/HCPCS documentation, validating charges against clinical records and applicable coding guidance, resolving pre-bill edits, and educating colleagues and clinical staff.

Requirements

Associate’s degree in healthcare, business administration, finance, accounting, or a related field, or equivalent experience in lieu of a degree.
Required coding credential: RHIA, RHIT, CCS, CPC/COC, AAPC, or another coding credential.
At least three years of relevant coding and charge-control work experience in a hospital and/or physician practice environment, with 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, and modifiers), charging processes and audits, and clinical billing.
Working knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing.
Knowledge of charge capture, reconciliation, error management operations, and overall revenue cycle operations.
Ability to research and analyze data, prepare reports and summaries, and support operational projects and leadership decisions.
Ability to follow complex tasks through to completion and manage concurrent tasks and projects.

Nice To Haves

CDC (Healthcare Compliance Certification) preferred.
CHRI certification or membership strongly preferred.
Knowledge of Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS) reimbursement structures, and pre-bill edits including OCE/CCI edits and DNFB.
Knowledge of clinical documentation improvement processes strongly preferred.

Responsibilities

Research, collect, and analyze information; identify opportunities, develop solutions, and lead work through resolution.
Collaborate on performance improvement activities related to program efficiency and patient experience.
Distribute analytical reports and use system applications to perform analysis, create reports, and develop educational materials.
Research and compile information for ad-hoc operational projects and initiatives; synthesize data into detailed summaries and graphical presentations that identify trends and recommend practical solutions.
Use operational data and measurements to define and demonstrate progress, return on investment, and impacts, supporting leadership decision-making.
Ensure accurate CPT/HCPCS documentation and educate colleagues and ancillary departments on documenting services and using appropriate codes.
Manage charge capture in assigned Revenue Integrity areas; review patient charts and related notes to interpret, validate, and extract charges.
Verify charges are associated with the correct patient, encounter, and date of service, with required modifiers.
Review documentation, abstract data, and ensure charges and coding align with AMA and Medicare guidelines.
Perform coding functions, including CPT and ICD-10 assignment, documentation review, and claim denial review.
Work pre-bill edits within key metrics, including OCE/CCI and DNFB.
Provide at-elbow support to ancillary departments, ensure appropriate supply and implant charge capture, identify duplicate charges, and communicate documentation or charge deficiencies and errors.
Perform charge entry, charge approvals, and quality charge reviews, including appending modifiers and checking clinical documentation; provide feedback to Revenue Integrity colleagues about improvement opportunities.
Code and/or validate charges for complex service lines, using advanced surgical or specialty coding proficiency.
Educate clinical staff on accurate and complete documentation to support revenue optimization and integrity.
Maintain working knowledge of applicable laws, regulations, compliance requirements, and organizational policies, procedures, and guidelines; follow ethical and safe work practices.
Incorporate Trinity Health's Mission, Values, Vision, Actions, and Promise into work behaviors, practices, and decisions.