Employment Type:

Shift:

Description:

Purpose

Work Remote Position

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: $31.8795-$47.8193)

Minimum Qualifications

Bachelors 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 Healths 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. 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

Indirect Healthcare / Support Services:

• 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

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.