Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice.
Reviews chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges. Ensures each chart is complete according to specified guidelines. Ensures charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers.
Reviews documentation, abstracts data and ensure charges/coding are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer regulations.
Performs coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review
Responsible for proofing daily charges for accuracy and clean claim submission
Responsible for balancing charges and adjustments
Maintains productivity standards
Maintains compliance with regulatory requirements
Responsible for denial coordination with Patient Business Service (PBS) centers, including analysis of clinical documentation, assisting in appeals, root cause analysis and tracking as needed.
Educates clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity.
Performs outpatient clinical documentation improvement review (acute only) as needed.
Performs research on charges and communicate findings to intra and inter-departmental colleagues.
Maintains a minimum productivity standard, based on service line and charge type; including but not limited to, chart review, charge extraction, E&M level assignment and charge entry.
Documents lessons learned and works with colleagues in Revenue Integrity department on creating standard charge capture and process reference materials. Assists with project initiatives to deploy information and provides education.
Reviews and responds to various quality reports, including reports that identify missing charges, duplicate charges, late charges, etc. Maintains and update required reference logs and other reporting tools. May develop and present information to various stakeholders.
Performs daily reconciliation processes including ensuring supply charges are appropriate captured (may include implants), identifies duplicate charges and initiates appropriate communications when there are documentation and/or charge deficiencies or charge errors as needed.
Maintains patient confidentiality.
Other duties as assigned.
High school diploma or equivalent combination of education and experience.
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.
Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credential. CHC (Healthcare Compliance Certification) and AAPC, AHIMA or CCSP certification/membership preferred.
Must possess a demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing. Strong understanding of various medical claim formats.
Knowledge of clinical documentation improvement processes strongly preferred.
Strong knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre-bill 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 and knowledge of working on appeals for insurance denials and identifying root cause
Knowledge of 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.
Ability to organize and to prioritize work in a diverse, fast-paced environment while working on multiple projects simultaneously.
Strong problem-solving skills, analytical abilities, excellent interpersonal, verbal and written communication skills. Ability to communicate effectively with other departments, including leadership, for the areas of charge capture, HIM, PBS and other key stakeholders.
Knowledge of billing and regulatory guidelines as related to charging and other revenue cycle processes and ability to assist clinical departments and/or physician practices with changes to their charging practices based on guidelines.
Experience with MS Excel, Word and PowerPoint preferred.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Maintains a working knowledge of applicable Federal, State, and Local laws and regulations, the Trinity Health Integrity and Compliance Program, including Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behaviors.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.