Specialist Charge Revenue Integrity - (Remote)

Trinity Health•Livonia, MI

6d•$25 - $38•Remote

About The Position

This is a remote, full-time position with a day shift. The Specialist Charge Revenue Integrity uses specialized knowledge to support key areas of the organization, leveraging data, research, analysis, critical thinking, and problem-solving skills to assist colleagues and leadership in achieving strategic objectives. This role serves as a peer influencer and may direct projects or teams, applying industry experience and specialized knowledge. The position is responsible for ensuring accurate CPT/HCPCS documentation for patient billing, educating colleagues on accurate service documentation and appropriate coding, and managing charge capture in assigned Revenue Integrity areas. This involves reviewing charts, validating charges, ensuring accuracy of patient, encounter, date of service, and modifiers, and aligning charges/coding with AMA and Medicare guidelines. The role also includes performing coding functions (CPT, ICD-10), reviewing claims denials, working pre-bill edits, providing "at-elbow support" to ancillary departments for charge capture, and performing charge entry, approvals, and quality reviews. Additionally, the Specialist educates clinical staff on documentation needs for revenue optimization and integrity and handles coding/validation for complex service lines.

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.
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 required.
Ability to follow tasks through to completion, understand and relate to complex ideas/concepts, remember multiple tasks and regimens over long periods of time, and work on concurrent tasks/projects.
Ability to read small print, hear sounds and voice/speech patterns, give/receive instructions and other verbal communications (in-person and/or over the phone/computer/device/equipment assigned) with some background noise.
Perform manual dexterity activities and/or grasping/handling.
Use a computer / other technology.
Sit with the ability to vary/adjust physical position or activity.
Maintain a safe working environment and 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.

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

Ensures accurate CPT/HCPCS documentation for the patient billing process.
Educates colleagues and ancillary departments on accurately documenting services and using appropriate codes.
Responsible for charge capture in Revenue Integrity assigned areas.
Reviews charts (nursing notes, physician orders, progress notes, surgical/specialty notes) to interpret, 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 with 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 OCE/CCI, & DNFB.
Provides "at-elbow support" to ancillary departments, ensuring supply charges are appropriately captured, identifying duplicate charges, and initiating communications for documentation/charge deficiencies or errors.
Performs charge entry, charge approvals, and/or quality charge reviews, including appending modifiers and checking clinical documentation.
Provides feedback to intra-departmental Revenue Integrity colleagues on areas of opportunity.
Responsible for coding and/or validation of charges for more complex service lines and advanced proficiencies in surgical or specialty coding practice.
Educates clinical staff on the need for accurate and complete documentation to ensure revenue optimization and integrity.
Researches, collects, and analyzes information to support ad-hoc operational projects and initiatives.
Synthesizes and analyzes data, providing detailed summaries with graphical presentations illustrating trends and recommending practical options or solutions.
Leverages program and operational data and measurements to define and demonstrate progress, ROI, and impacts.
Maintains a working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity and Compliance Program, Code of Conduct, and other policies/procedures/guidelines.