Employment Type:

Shift:

Description:

Purpose

Work Remote Position

(Pay Range: $24.5303-$36.7954)

Provides oversight & support of the workflow & functions in accordance with level of experience education & standards. Assumes an expanded role & increased responsibility including delegating to others. Participates in the development of & the process improvement of policies & procedures. Works closely with leadership to maintain efficient & effective operations to ensure quality in daily operations.
May partner with leadership with the selection orientation & performance feedback of the team. Works cooperatively to ensure that key customer needs are being met & achievement of operational & performance goals.

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:
Coordinates operational technical & / or clerical support services that enhance or improve coordination preparation & flow of the department process & core work.
Plans & organizes workflows & prioritizes customers needs.
May lead a small team; serves as a mentor.
Creates & maintain procedural standards & records as appropriate for role.
Develops & maintains educational programs for the team members including new employee orientation.
Process Focus:
Utilizes multiple system applications for data collection & management.
Incorporates basic knowledge of Trinity Health policies practices & processes to ensure quality confidentiality & safety are prioritized.
Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
Collaborate on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
Helps to identify opportunities develop solutions & lead the team through resolution.
Communication:
Employs effective & respectful written verbal & nonverbal communications;
Develops an environment of mutual confidence & trust through collaborative relationships;
Effectively communicates goals standards program expectations service performance & how the work serves Trinity Health objectives;
Proactively recognizes addresses & / or escalates organizational operational & / or team conflicts.
Environment:
Performs work in a caring collaborative & safe manner that complies with regulatory standards.
Maintains a safe functional & organized workspace environment.
Stewards productive use of resources (e.g. people financial equipment supplies materials) to achieve assigned commitments experiences & quality standards.
Accountable for continuous role-based self-development & leadership growth.
Supports the professional growth of team members. Self-monitors & initiates corrections & / or seeks assistance & / or guidance when needed.
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/HCPCS documentation for the patient billing process and educating colleagues and ancillary departments in accurately documenting services performed and using the appropriate codes representing those services.

Responsible for charge capture in Revenue Integrity assigned areas.

Reviews chart including nursing notes physician orders progress notes and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges.

Verifies 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 within AMA and Medicare coding guidelines.

Performs coding functions including CPT ICD-10 assignment documentation review and claim denial review

Responsible for working the pre-bill edits within key metrics including but not limited to OCE/CCI & DNFB.

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.

Performs charge entry 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.

Responsible for coding and/or validation of charges for more complex service lines advanced proficiencies in surgical or specialty coding practice.

Educates clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity.

Minimum Qualifications

Associates degree in healthcare business administration finance accounting or related field or equivalent experience considered in lieu of degree.

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.

Must possess a demonstrated knowledge of clinical processes charge master maintenance 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 charge capture reconciliation error management operations & overall revenue cycle operations required.

Additional Qualifications (nice to have)

Registered Nurse strongly preferred

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).

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. Frequent
• 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. 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. 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.