Specialist Charge (Charge Capture Coder Auditor) Revenue Integrity (Remote)

Trinity Health Mid-Atlantic; Livonia (MI); Remote; USD 34,000 - 52,000; Full time

Job summary

Trinity Health in Livonia, Michigan is seeking a Data Analyst focused on data capture, analysis, and reporting to support operational efficiency and leadership decision making. The role includes auditing department information, generating reports, and recommending process improvements within the revenue integrity and coding workflow.

Responsibilities include ensuring accurate CPT/ICD-10 documentation for billing, educating colleagues on coding, reviewing charge capture, and coordinating with

Qualifications

• Bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or related field.
• Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
• Experience with Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including OCE/CCI edits.
• Ability to perform charge capture processes and investigate charge errors with EMR integration.
• Epic experience is desired.
• Experience with revenue cycle front-end and back-end functions that may impact charge related errors.

Responsibilities

• Ensure accurate CPT and/or ICD-10 documentation for the patient billing process and educate colleagues and providers in accurately document services performed and using the appropriate codes.
• Maintain documentation regarding charge capture processes and perform regular reviews of process adherence to identify missing charges.
• Coordinate with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy.
• Provide oversight of charge reconciliation processes for assigned departments; ensuring daily and monthly reconciliations are occurring.
• Perform daily charge entry/capture functions, charge approvals, and/or quality charge reviews; including modifiers and checking clinical documentation.
• Provide feedback to Revenue Integrity colleagues including areas of opportunity and supporting denial related charge reviews.

Skills

Data analysis

Data visualization

Charge capture

Billing compliance

HIPAA knowledge

Education

Bachelor's or associate degree in Healthcare or related field

High school diploma or GED

Tools

Epic

Job description

Employment Type: Full time Shift: Day Shift Description: Purpose Work Remote Position (Pay Range: $25.0209-$37.5313) Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. Note: \"patients\" refers to patients, clients, residents, participants, customers, members.

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.

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)

Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes. Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. Performs charge entry/capture functions, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues including areas of opportunity. Assist Nurse Auditor and/or other stakeholders with denial related charge reviews, including analysis of clinical documentation, root cause analysis and education to the responsible ancillary department. Performs daily reconciliation processes and/or provides \"at-elbow support\" to ancillary departments including but not limited to; ensuring supply charges are appropriate captured (may include implants), identify duplicate charges and initiate appropriate communications when there are documentation and/or charge deficiencies or charge errors.

Minimum Qualifications

• High school diploma or GED
• Minimum three (3) years of relevant coding and charge control work experience in a hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services.
• Experience working with current clinical processes, charge master maintenance, clinical coding guidelines, charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.
• Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
• Experience working with Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).
• Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly.
• Epic experience desired.
• Experience working with Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors.

Additional Qualifications (nice to have)

Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure is required. CHC (Healthcare Compliance Certification) preferred. CHRI certification/membership strongly preferred. Knowledge of clinical documentation improvement processes 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. Continuous 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 Direct Healthcare Services: Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional 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. Occasional Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional Indirect Healthcare / Support Services: Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional 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 Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment 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. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we're 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.