Revenue Integrity Charge Specialist (Remote)
- Livonia, MI
- Permanent
- Part-time
Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.Functional Role (not inclusive of titles or advancement career progression)Performs activities that relate to charge monitoring & follow-up.Conducts set-up & maintenance of the Charge Description Master (CDM) & support coverage of other departmental functions.Collaborates with Physicians, Medical Records / Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance & Managed Care department staffs.Audits Charge Master for each department including review of appropriate coding, departmental and pricing concerns; and ensuring proper recording of transactions and compliance with state and federal guidelines reating to charge capture and billing of services.Works with Information Systems & other departments to ensure that the appropriate Charge Description Master (CDM) & other necessary billing data are placed on the claim appropriately including ancillary or clinical systems related to revenue cycle, charge capture & billing.Assists in the approval of implementation of charge codes & charge practices.Provides input & recommendations related to charges for new services & all service lines.Guides, communicates & educates on correct charge capture, billing & coding processes & local, state & federal guidelines.Examines, reports & makes recommendations regarding departmental charge activities for compliance with management plans & policies.Conducts special reviews for management to discover mechanics of detected fraud & to develop controls for fraud prevention.Reviews bulletins to maintain an understanding of regulatory & payer changes to assure correct charging & billing.Coordinates pricing increases as directed by Finance & utilizes strategic pricing applications to maximize payments within the hospital budget requirements.(Pay Range: $31.8795-$47.8193)Minimum QualificationsBachelor's degree in healthcare or business administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education & experience.Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.Must possess a demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging processes & audits & clinical billing.Working knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to charge documentation, capture & billing is required.Knowledge of Ambulatory Payment Classification (APC) & Outpatient Prospective Payment System (OPPS) reimbursement structures & prebill edits including Outpatient Coding Edits (OCE) / Correct Coding Initiative (CCI) edits & Discharged Note Final Billed (DNFB).Additional Qualifications (nice to have)Experience with CDM oversight strongly preferred.Licensure /Certification: RHIA, RHIT, CCS, CPC / COC or other coding credentials strongly preferred.CDC (Healthcare Compliance Certification) and CHRI (Certificate in Healthcare Revenue Integrity) are strongly preferred.Physical & Mental Requirements & Working Conditions (General Summary)Direct Healthcare Services / Indirect Healthcare / Support Services:
- Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
- Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
- Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
- Exposure to interruptions, shifting priorities & stressful situations. Frequent
- Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
- Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent
- Perform manual dexterity activities & /or grasping / handling. Occasional
- Ability to climb, kneel, crouch & / or operate foot controls. Occasional
- Use a computer / other technology. Frequent
- Sit with the ability to vary / adjust physical position or activity. Frequent
- Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
- Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines. Continuous
- Ability to provide assistance in the event of an emergency. Occasional
- Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent
- Lift a maximum of 30 pounds unassisted. Occasional
- Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
- Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
- Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Continuous
- Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional
- Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent
- Lift a maximum of 30 pounds unassisted. Occasional
- Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
- Encounter a clinical / patient facing / hands on interactive work environment. Occasional
- Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
- Work outdoors with variable external environmental conditions. Occasional