Responsibilities
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Review's 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.
- Review's 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.
Requirements
- Associate’s 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.
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
Additional Information
- 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 Health’s 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.
