Employment Type:

Full time

Shift:

Day Shift

Description:

Responsible to ensure accurate CPT and/or ICD-10 documentation for the patient billing process. Responsible for educating colleagues and providers in accurately documenting 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. Work closely with Revenue Integrity staff and providers to educate on improved documentation to support coding.

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, assisting in appeals, 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.

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. Maintains and update required reference logs and other reporting tools. May develop and present information to various stakeholders.

Performs daily reconciliation processes including ensuring supply charges are appropriate captured (may include implants), identifies duplicate charges and initiates appropriate communications when there are documentation and/or charge deficiencies or charge errors as needed.

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 credential. CHC (Healthcare Compliance Certification) and 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 pre-bill 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, including 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.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office environment. The area is well lit, Temperature controlled and free from hazards.

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.

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.

EOE including disability/veteran