Employment Type:

Full time

Shift:

Day Shift

Description:

POSITION 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 m