Revenue Integrity Charge Specialist - (Part-Time-32 Hours Per Week - Day Shift) (Remote)

About the position

Day Shift Position - Part-Time -32 Hours Per Week - Day Shift)

Work Remote Position

(Pay Rate: $24.5303-$36.7954)

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

Essential Functions

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: $24.5303-$36.7954)

Responsibilities
• 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.

Requirements
• Bachelor'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).

Nice-to-haves
• 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.

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