Charge Revenue Integrity Specialist

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Conduct research, gather, and assess information; recognize opportunities, formulate solutions, and guide through resolution.

• Collaborate on initiatives aimed at performance enhancement focusing on program efficiency and patient experience outcomes.

• Prepare and distribute analytical reports.

• Utilize various system applications to conduct analysis, generate reports, and create educational materials.

• Investigate and compile information for ad-hoc operational projects and initiatives.

• Analyze data and deliver detailed summaries complemented by graphical trend presentations and actionable recommendations.

• Utilize program and operational data to clarify and showcase progress, ROI, and impacts.

• Ensure precise CPT/HCPCS documentation for patient billing while educating colleagues and ancillary departments on documentation and coding practices.

• Execute charge capture in designated Revenue Integrity areas.

• Examine charts and documentation to interpret, validate, and extract charges.

• Confirm charges against the appropriate patient, encounter, date of service, and necessary modifiers.

• Perform CPT and ICD-10 coding, documentation assessments, and claims denial reviews.

• Manage pre-bill edits including OCE/CCI and DNFB within essential metrics.

• Provide direct support to ancillary departments, such as in supply-charge capture, duplicate-charge identification, and deficiency/error communication.

• Conduct charge entry, approvals, and quality charge reviews, including checks for modifiers and clinical documentation.

• Code and/or validate charges for intricate service lines and surgical or specialty coding.

• Educate clinical staff on accurate and comprehensive documentation for optimizing revenue and maintaining integrity.

• Stay updated on relevant laws, regulations, Trinity Health compliance standards, policies, procedures, and guidelines.

⛳️ Requirements

• An associate’s degree in healthcare, business administration, finance, accounting, or a related field, or equivalent experience considered in lieu of a degree.

• Required coding credentials include RHIA, RHIT, CCS, CPC/COC, AAPC, or other relevant certifications.

• A minimum of three (3) years of pertinent coding and charge control work experience in a hospital and/or physician practice setting.

• Experience in revenue cycle management, billing, coding, and/or patient financial services.

• Proven understanding of clinical processes, charge master upkeep, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging procedures & audits, and clinical billing.

• Familiarity with third-party payer rules and requirements, computer operations, and electronic interfaces pertaining to charge documentation, capture, and billing.

• Knowledge of charge capture, reconciliation, error management operations, and the overall revenue cycle process.

• CDC certification is preferred.

• CHRI certification/membership is strongly preferred.

• Understanding of APC, OPPS reimbursement structures, OCE/CCI edits, and DNFB.

• Knowledge of clinical documentation improvement processes is strongly preferred.

🏝️ Benefits

• Comprehensive health, dental, and vision plans.

• Retirement savings options with company match.

• Paid time off and holiday pay.

• Professional development opportunities and continuing education support.

• Employee assistance programs and wellness initiatives.