Specialist Charge, Coder, Revenue Integrity

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

📋 Description

• Conduct research, gather, analyze, and present data to enhance operational efficiency and support leadership in decision-making.

• Review departmental information, generate analytical reports, and recommend improvements to processes.

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

• Integrate data and deliver comprehensive summaries, graphical trend analyses, ROI evaluations, and actionable recommendations.

• Gather and analyze information; pinpoint opportunities, devise solutions, and guide through to resolution.

• Work collaboratively on initiatives aimed at enhancing program efficiency and patient experience.

• Leverage multiple system applications to conduct analyses, generate reports, and create educational materials.

• Ensure precise CPT and/or ICD-10 documentation for patient billing and provide education to colleagues and providers on proper documentation and coding practices.

• Maintain documentation for the charge capture process and assess adherence to procedures to identify any missing charges.

• Collaborate with stakeholders regarding system change requests and process enhancements.

• Oversee charge reconciliation for designated departments, including both daily and monthly reconciliations.

• Execute charge entry and capture, approve charges, conduct quality charge reviews, append modifiers, and check clinical documentation.

• Support denial-related charge reviews, analyze clinical documentation, perform root cause analysis, and educate relevant ancillary departments.

• Conduct daily reconciliations and provide on-site support to ancillary departments, including validating supply charges, identifying duplicate charges, and communicating documentation or charge deficiencies.

⛳️ Requirements

• High school diploma or GED.

• At least three (3) years of pertinent coding and charge control experience within a hospital and/or Physician Practice environment, with a background in revenue cycle, billing, coding, and/or patient financial services.

• Familiarity with current clinical processes, charge master upkeep, clinical coding guidelines, charging processes and audits, and clinical billing, typically acquired through a bachelor’s or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.

• Strong knowledge of medical terminology, data entry, supply chain processes, and operations of hospital and/or Medical Group practices.

• Experience with Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), Outpatient Coding Edits (OCE), Correct Coding Initiative (CCI) edits, and Discharged Note Final Billed (DNFB).

• Capability to execute charge capture processes and comprehend the technical integration of electronic medical records and automated charge triggers.

• Experience with Epic is preferred.

• Familiarity with revenue cycle functions at both the front-end and back-end within hospital and/or Physician group practices.

• Required credentials include RHIA, RHIT, CCS, CPC/COC, or other coding certifications and/or licensure as a Licensed Vocational Nurse/Licensed Practical Nurse.

• CHC certification is preferred.

• Strong preference for CHRI certification/membership.

• Knowledge of clinical documentation improvement processes is highly preferred.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork and collaboration.

• Access to comprehensive health and wellness programs.