Specialist Charge Revenue Integrity – Surgery Coding

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

📋 Description

• Conduct research, gather, and evaluate information to uncover opportunities and devise solutions.

• Drive performance enhancement initiatives focusing on program efficiency and patient experience outcomes.

• Prepare and distribute analytical reports.

• Utilize various system applications to perform analyses, generate reports, and create educational materials.

• Research and assemble information for ad-hoc operational projects and initiatives.

• Synthesize and analyze data, deliver detailed summaries and graphical trend presentations, and suggest practical options or solutions.

• Use program and operational data to delineate and showcase progress, ROI, and impacts.

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

• Execute charge capture in designated Revenue Integrity areas.

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

• Confirm that charges are correctly assigned to the appropriate patient, encounter, date of service, and necessary modifiers.

• Review documentation and abstract data to align charges/coding with AMA and Medicare coding guidelines.

• Conduct CPT and ICD-10 coding, documentation review, and claim denial analysis.

• Manage pre-bill edits including OCE/CCI and DNFB while adhering to key metrics.

• Provide on-site support to ancillary departments, addressing supply-charge capture, duplicate-charge identification, and correcting documentation or charge discrepancies/errors.

• Perform charge entry, charge approvals, and quality charge reviews, which include appending modifiers and verifying clinical documentation.

• Offer feedback to Revenue Integrity colleagues on areas for improvement.

• Code and/or validate charges for complex service lines and advanced surgical or specialty coding practices.

• Educate clinical staff on accurate and complete documentation to optimize revenue and maintain integrity.

• Adhere to Trinity Health’s mission, values, policies, procedures, Code of Conduct, and safety practices.

⛳️ 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 experience in a hospital and/or Physician Practice setting, along with experience in revenue cycle, billing, coding, and/or patient financial services.

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

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

• Understanding of charge capture, reconciliation, error management operations & overall revenue cycle operations.

• CDC (Healthcare Compliance Certification) is preferred.

• CHRI certification/membership is strongly preferred.

• Knowledge of Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), OCE/CCI edits, and DNFB.

• Ability to see tasks through to completion, comprehend and relate to intricate ideas/concepts, remember multiple tasks and procedures over extended periods, and manage concurrent tasks/projects.

• Capacity to read small print, discern sounds and voice/speech patterns, and give/receive instructions and oral communications.

• Proficient in computer/technology use.

• Capability to maintain a safe working environment and utilize available PPE.

• Ability to assist during emergencies.

• Occasional capacity to lift up to 30 pounds unassisted.

🏝️ Benefits

• Remote work opportunity.

• Day shift hours.

• Equal Opportunity Employer.