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.
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.
Remote Work Opportunity
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.
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. 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.
Review's documentation, abstracts data and ensure charges/coding are in alignment within 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
Assist Nurse Auditor and/or Coordinator with denial coordination process; including analysis of clinical documentation, 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 to departmental colleagues.
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 and/or 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.
Maintains patient confidentiality.
Other duties as assigned.
Hourly pay range: $22.8413 - $34.1960
Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.
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 and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure is required. CHC (Healthcare Compliance Certification) preferred. CHRI certification/membership strongly 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).
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.
Experience and knowledge of working on appeals for insurance denials and identifying root cause.
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 to ensure adherence in a manner that reflects honest, ethical, and professional behaviors.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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