Revenue Integrity Charge Specialist - REMOTE at Trinity Health

Ann Arbor, Michigan, United States -

Full Time

Start Date

Immediate

Expiry Date

30 May, 26

Salary

0.0

Posted On

01 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

CPT Coding, ICD-10 Documentation, Charge Capture, Charge Reconciliation, Modifier Appending, Clinical Documentation, Surgical Coding, Specialty Coding, HCPCS Coding, Revenue Cycle, Claim Denial Review, Root Cause Analysis, APC/OPPS, CCI Edits, Epic, MS Excel

Industry

Hospitals and Health Care

Description

Employment Type: Full time Shift: Description: Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. 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. Works closely with Providers to educate on improved documentation to support coding. As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs. Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation, serving communities in 21 states with 86 hospitals, 128 continuing care facilities and home health and hospice programs ESSENTIAL FUNCTIONS Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice. Reviews chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges. Ensures each chart is complete according to specified guidelines. Ensures charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers. Reviews documentation, abstracts data and ensure charges/coding are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer regulations. Performs coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review Responsible for proofing daily charges for accuracy and clean claim submission Responsible for balancing charges and adjustments Maintains productivity standards Maintains compliance with regulatory requirements Responsible for denial coordination with Patient Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed. Educates clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity. Performs outpatient clinical documentation improvement review (acute only) as needed. Performs research on charges and communicate findings to intra and inter-departmental colleagues as needed. Maintains a minimum productivity standard, based on service line and charge type; including but not limited to: chart review, charge extraction, E&M level assignment and charge entry. Documents lessons learned and works with colleagues in Revenue Integrity department on creating standard charge capture and process reference materials. Assists with project initiatives to deploy information and provides education. Reviews and responds to various quality reports, including reports that identify missing charges, duplicate charges, late charges, etc. Maintain and update required reference logs and other reporting tools. May develop and present information. As needed, performs daily reconciliation processes including 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. Maintains patient confidentiality. Other duties as assigned. QUALIFICATIONS High school diploma or equivalent combination of education and experience. 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. Strong working knowledge of Medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials is required. CHC (Healthcare Compliance Certification) preferred. AAPC, AHIMA or CCSP certification/membership preferred. Must possess a demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing. Strong understanding of various medical claim formats. Knowledge of clinical documentation improvement processes strongly preferred. Strong knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). Prior cardiac cath/interventional radiology charging/coding experience strongly preferred. Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired. Knowledge of Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors. Ability to organize and to prioritize work in a diverse, fast-paced environment while working on multiple projects simultaneously. Strong problem-solving skills, analytical abilities, excellent interpersonal, verbal and written communication skills. Ability to communicate effectively with other departments, including leadership, for the areas of charge capture, HIM, PBS and other key stakeholders. Knowledge of billing and regulatory guidelines as related to charging and other revenue cycle processes and ability to assist clinical departments and/or physician practices with changes to their charging practices based on guidelines. Experience with MS Excel, Word and PowerPoint preferred. Must be comfortable operating in a collaborative, shared leadership environment. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. Maintains a working knowledge of applicable Federal, State, and Local laws and regulations, the Trinity Health Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behaviors. 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. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.

Responsibilities

The specialist is responsible for ensuring accurate CPT and/or ICD-10 documentation for patient billing, educating providers on proper coding, and performing regular reviews to identify and capture missing charges. This role involves charge entry, approvals, quality reviews, and coordinating charge reconciliation processes for assigned departments.