Specialist Charge Revenue Integrity - (Remote)

Purpose

Work Remote Position

(Pay Range: $25.0209-$37.5313)

 Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

Note: “patients” refers to patients, clients, residents, participants, customers, members

Essential Functions 

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
Work Focus:

• 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. 

Process Focus:

• 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.

Data Management & Analysis:

• 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.

Functional Role (not inclusive of titles or advancement career progression)

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.

Minimum Qualifications

 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.  

Additional Qualifications (nice to have)

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

Physical & Mental Requirements & Working Conditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).      Occasional
• Exposure to or subject to noise, infectious waste, diseases & conditions.     Occasional
• Exposure to interruptions, shifting priorities & stressful situations.      Frequent
• 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.     Frequent
• 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.     Frequent
• Perform manual dexterity activities & / or grasping / handling.     Frequent
• Ability to climb, kneel, crouch & / or operate foot controls.     Occasional
• Use a computer / other technology.     Frequent
• Sit with the ability to vary / adjust physical position or activity.     Frequent
• Maintain a safe working environment & use available personal protective equipment (PPE).     Continuous
• Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines.     Continuous
• Ability to provide assistance in the event of an emergency. Occasional

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.     Occasional
• Lift a maximum of 30 pounds unassisted.     Occasional
• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling.     Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.     Continuous
• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients).     Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.     Frequent
• Lift a maximum of 30 pounds unassisted.     Occasional
• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing.   Occasional
• Encounter a clinical / patient facing / hands on interactive work environment.     Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.     Continuous
• Work outdoors with variable external environmental conditions.      Occasional

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.