Charge Specialist, Revenue Integrity

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

📋 Description

• Conduct research, gather, and evaluate information; pinpoint opportunities, devise solutions, and guide through to resolution.

• Partner on initiatives aimed at enhancing performance based on program effectiveness and patient experience outcomes.

• Generate and distribute analytical reports.

• Utilize various system applications to conduct analyses, produce reports, and create educational materials.

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

• Synthesize and assess data; deliver comprehensive summaries and graphical presentations that highlight trends and propose actionable solutions.

• Utilize program and operational data to establish and exhibit progress, return on investment (ROI), and impacts.

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

• Execute charge capture in designated Revenue Integrity areas.

• Evaluate charts, nursing notes, physician orders, progress notes, and surgical or specialty notes to interpret, validate, and/or extract charges.

• Confirm that charges are linked with the correct patient, encounter, date of service, and necessary modifiers.

• Review documentation, abstract data, and align charges/coding with AMA and Medicare coding standards.

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

• Manage pre-bill edits including OCE/CCI and DNFB within established key performance indicators.

• Offer on-site support to ancillary departments, encompassing supply and implant charge capture, identification of duplicate charges, and resolution of documentation or charge discrepancies.

• Conduct charge entry, charge approvals, and quality reviews of charges, including modifier appending and clinical documentation checks.

• Provide feedback to Revenue Integrity team members regarding areas for improvement.

• Code and/or validate charges for complex service lines, including surgical or specialty coding.

• Train clinical staff on accurate and complete documentation for optimizing revenue and integrity.

• Adhere to Trinity Health’s Mission, Values, Vision, Actions, Promise, Code of Conduct, policies, procedures, and safety protocols.

⛳️ Requirements

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

• Coding credentials such as RHIA, RHIT, CCS, CPC/COC, AAPC, or others are required.

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

• Familiarity with revenue cycle, billing, coding, and/or patient financial services.

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

• Proficient understanding of third-party payer regulations and requirements, computer operations, and electronic interfaces pertinent to charge documentation, capture, and billing.

• Knowledgeable in charge capture, reconciliation, error management operations, and overall revenue cycle processes.

• Familiarity with departmental procedures and the capacity to acquire new knowledge.

• Working knowledge of relevant federal, state, and local laws/regulations, Trinity Health's Integrity & Compliance Program, Code of Conduct, policies, procedures, and guidelines.

• CDC (Healthcare Compliance Certification) is preferred.

• CHRI certification/membership is strongly preferred.

• Knowledge of APC, OPPS reimbursement structures, OCE/CCI edits, DNFB, and clinical documentation improvement processes is strongly preferred.

• Capability to operate computers and other technology, complete tasks thoroughly, grasp complex concepts, manage multiple tasks/projects simultaneously, and maintain a safe working environment.

🏝️ Benefits

• Opportunity for remote work.

• Equal Opportunity Employer.

• Consideration provided 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.