Address
Form of work
SalaryPOSITION PURPOSE
Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and collaborates with intra-departmental team members to identify root cause. Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately. May be required to travel between locations within the Region.
As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.
ESSENTIAL FUNCTIONS
1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions
2. Responsible for working the pre-bill edits within bill drop window, including but not limited to OCE/CCI, claim scrubber edits, and DNFB. Collaborates with intra-departmental team to determine root cause. Meets expected performance metrics and goals.
3. Assists inter and intra-departmental teams on denial investigations and root cause analysis. Including identifying opportunities for denial prevention through the revenue cycle.
4. Performs other revenue optimization activities as appropriate and may assist centralized charge control team when necessary.
5. Maintains an understanding of regulatory and payer changes to ensure correct charging and billing requirements are met.
6. Works with Patient Business Service (PBS) center on requests to or from PBS as needed for payer requests and/or claim adjudication.
7. Maintains working knowledge of coding and billing regulations for all payors. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance, and optimization.
8. Other duties, as assigned.
9. Maintains a working knowledge of applicable Federal, State, and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
MINIMUM QUALIFICATIONS
1. Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, AAPC or other coding credentials and/or Licensed Vocational Nurse/ Licensed Practical Nurse strongly preferred. CDC (Healthcare Compliance Certification) preferred. CHRI certification/membership strongly preferred.
2. Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's or Associate’s degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.
3. Three (3) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.
4. Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.
5. Working knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required.
6. Must possess a demonstrated knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing.
7. Knowledge of 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).
8. Must be able to work in an environment that may be stressful with a variety of individuals having diverse personalities and work styles.
9. Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
10. Possess strong analytical, interpersonal, written, and verbal communication skills.
11. Knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
1. This position operates in a typical office and/or home office environment. The area is well lit, temperature controlled and free from hazards.
2. Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.
3. Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.
4. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.
5. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
6. Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.
7. Must possess the ability to comply with Trinity Health policies and procedures.
8. May be require travelling up to 10% between locations within the Region.
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
