Specialist Charge-RIO

Role Description

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.

Essential Functions

• Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
• 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

• Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services.
• Maintains documentation regarding charge capture processes.
• Performs regular reviews of process adherence and identify missing charges.
• Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy.
• Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring.
• Performs charge entry/capture functions, 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.
• Assist Nurse Auditor and/or other stakeholders with denial related charge reviews, including analysis of clinical documentation, root cause analysis and education to the responsible ancillary department.
• Performs daily reconciliation processes and/or 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.

Qualifications

• High school diploma or GED.
• 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.
• Experience working with current clinical processes, charge master maintenance, clinical coding guidelines, charging processes and audits, and clinical billing as normally obtained through a bachelor's or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.
• Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
• Experience working with 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).
• Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired.
• Experience working with Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors.

Additional Qualifications

• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure is required.
• CHC (Healthcare Compliance Certification) preferred.
• CHRI certification/membership strongly preferred.
• Knowledge of clinical documentation improvement processes strongly preferred.

Physical & Mental Requirements & Working Conditions

• 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.
• Continuous ability to climb, kneel, crouch & / or operate foot controls.
• Frequent use of a computer / other technology.
• Frequent sit with the ability to vary / adjust physical position or activity.
• Continuous maintain a safe working environment & use available personal protective equipment (PPE).
• Continuous comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines.
• Occasional ability to provide assistance in the event of an emergency.
• Occasional 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.
• Occasional encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.
• Occasional perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients).

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.