Specialist Charge Revenue Integrity (Cardiology) - (Remote)

Trinity Health•Livonia, MI

6d•$22 - $33•Remote

About The Position

This remote, full-time, day-shift role uses specialized knowledge, research, data analysis, critical thinking, and problem-solving to support organizational objectives. The specialist may influence peers and direct projects or project teams. The position supports charge revenue integrity, with a focus on cardiology, and ensures accurate documentation, coding, charge capture, and billing. It also analyzes operational data, prepares reports and educational materials, supports performance improvement, and advises colleagues and clinical departments on documentation and charge accuracy. The role reviews patient charts and documentation, validates charges, performs coding and charge reviews, works pre-bill edits, and supports charge capture in assigned areas. It applies applicable coding guidelines and payer requirements, identifies charge or documentation issues, and educates clinical staff and colleagues. The position also maintains knowledge of relevant laws, regulations, organizational policies, and compliance standards. The position is remote. The posting describes occasional exposure to potentially unpleasant conditions, hazards, noise, and infectious waste, as well as frequent interruptions and shifting priorities. It also lists physical demands such as occasional lifting up to 30 pounds, standing or walking, and bending or reaching; computer use and sitting are frequent. Some conditions listed apply to direct healthcare, indirect healthcare, or support services generally.

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 analyze data, prepare reports and summaries, communicate recommendations, and support leadership decision-making.
Ability to maintain confidentiality and comply with applicable laws, regulations, organizational policies, procedures, and guidelines.

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 issues through resolution.
Collaborate on performance improvement activities based on program efficiency and patient experience outcomes.
Distribute analytical reports.
Use multiple system applications to analyze information, create reports, and develop educational materials.
Research and compile information for ad-hoc operational projects and initiatives.
Synthesize and analyze data; provide detailed summaries and graphical presentations showing trends and recommending practical options or solutions to support leadership decisions.
Use program and operational data and measures to demonstrate progress, return on investment, and impacts.
Maintain working knowledge of applicable laws, regulations, organizational policies, and compliance requirements, and follow safe, ethical, and professional practices.
Ensure accurate CPT/HCPCS documentation for patient billing and educate colleagues and ancillary departments on documentation and appropriate coding.
Manage charge capture in assigned Revenue Integrity areas.
Review charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes, to interpret, validate, and extract charges.
Verify that charges are associated with the correct patient, encounter, and date of service, and include required modifiers.
Review documentation and abstract data to ensure charges and coding align with AMA and Medicare coding 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-the-elbow support to ancillary departments, including ensuring appropriate supply and implant charge capture, identifying duplicate charges, and communicating 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 on opportunities for improvement.
Code and/or validate charges for more complex service lines, using advanced surgical or specialty coding proficiency.
Educate clinical staff on the need for accurate and complete documentation to support revenue optimization and integrity.