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.
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions
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.
Assists inter and intra-departmental teams on denial investigations and root cause analysis. Including identifying opportunities for denial prevention through the revenue cycle.
Performs other revenue optimization activities as appropriate and may assist centralized charge control team when necessary.
Maintains an understanding of regulatory and payer changes to ensure correct charging and billing requirements are met.
6. Communicates and follows-up with designated Utilization Review staff regarding clinical denials. Works with Patient Business Service (PBS) center on requests to or from PBS as needed for payer requests and/or claim adjudication.
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.
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 in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
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 degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of years of education and experience.
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.
Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.
Working knowledge of third party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.
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.
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).
Must be able to work in an environment that may be stressful with a variety of individuals having diverse personalities and work styles.
Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
Possess strong analytical, interpersonal, written and verbal communication skills.
Knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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