Specialist Charge Revenue Integrity – Surgery Coding

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

📋 Description

• Conduct research, gather, and analyze data to pinpoint opportunities and formulate solutions.

• Collaborate on initiatives aimed at enhancing performance based 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.

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

• Synthesize and analyze data, providing comprehensive summaries and graphical presentations, highlighting trends, and suggesting practical solutions.

• Utilize program and operational data to define and illustrate progress, ROI, and impacts.

• Ensure precise CPT/HCPCS documentation for patient billing purposes.

• Educate colleagues, clinical staff, and ancillary departments on accurate documentation and proper coding practices.

• Execute charge capture and review medical records, nursing notes, physician orders, progress notes, and surgical or specialty notes to validate or extract charges.

• Confirm that charges are allocated to the correct patient, encounter, service date, and necessary modifiers.

• Review documentation to ensure charges and coding are in accordance with AMA and Medicare coding standards.

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

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

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

• Carry out charge entry, charge approvals, and quality charge reviews, which include modifier appending and clinical documentation checks.

• Validate charges for complex service lines and surgical or specialty coding practices.

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

⛳️ Requirements

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

• RHIA, RHIT, CCS, CPC/COC, AAPC, or other coding credentials are mandatory.

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

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

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

• Familiarity with third-party payer regulations and requirements.

• Understanding of computer operations and electronic interfaces related to charge documentation, capture, and billing.

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

• Understanding of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits such as OCE/CCI and DNFB.

• CDC certification is preferred.

• CHRI certification/membership is strongly preferred.

• Capability to research, gather, analyze, synthesize, and summarize data.

• Proficiency in creating reports and graphical data presentations.

• Ability to utilize various system applications and technology.

• Capacity to maintain confidentiality, safety, and ensure compliance with applicable laws, regulations, policies, and guidelines.

• Capability to perform the necessary physical and mental activities, including computer use, reading small print, verbal communication, manual dexterity, and occasional lifting of up to 30 pounds.

🏝️ Benefits

• Remote work position.

• Commitment to being an Equal Opportunity Employer.

• A person-centered, compassionate workplace culture.