Employment Type:Full timeShift:Day Shift

Description:

Purpose

Work Remote Position

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.

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: 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 (not inclusive of titles or advancement career progression)

Performs activities that relate to charge monitoring & follow-up.

Conducts set-up & maintenance of the Charge Description Master (CDM) & support coverage of other departmental functions.

Collaborates with Physicians, Medical Records / Health Information Management, Ancillary, Nursing, Patient Business Service (PBS) center, Information Services, Compliance & Managed Care department staffs.

Audits Charge Master for each department including review of appropriate coding, departmental and pricing concerns; and ensuring proper recording of transactions and compliance with state and federal guidelines reating to charge capture and billing of services.

Works with Information Systems & other departments to ensure that the appropriate Charge Description Master (CDM) & other necessary billing data are placed on the claim appropriately including ancillary or clinical systems related to revenue cycle, charge capture & billing. 

Assists in the approval of implementation of charge codes & charge practices.

Provides input & recommendations related to charges for new services & all service lines.

Guides, communicates & educates on correct charge capture, billing & coding processes & local, state & federal guidelines.  

Examines, reports & makes recommendations regarding departmental charge activities for compliance with management plans & policies.  

Conducts special reviews for management to discover mechanics of detected fraud & to develop controls for fraud prevention.  

Reviews bulletins to maintain an understanding of regulatory & payer changes to assure correct charging & billing.     

Coordinates pricing increases as directed by Finance & utilizes strategic pricing applications to maximize payments within the hospital budget requirements.  

Pay Range: $31.8795-$47.8193)

Minimum Qualifications

Bachelor's degree in healthcare or business administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education & experience.

Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.

Must possess a demonstrated knowledge of charge master maintenance, clinical processes, 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 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). 

Additional Qualifications (nice to have)

Experience with CDM oversight strongly preferred.  

Licensure /Certification: RHIA, RHIT, CCS, CPC / COC or other coding credentials strongly preferred.

CDC (Healthcare Compliance Certification) and CHRI (Certificate in Healthcare Revenue Integrity) are 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. OccasionalExposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).      OccasionalExposure to or subject to noise, infectious waste, diseases & conditions.     OccasionalExposure to interruptions, shifting priorities & stressful situations.      FrequentAbility 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.     FrequentAbility 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.     FrequentPerform manual dexterity activities & /or grasping / handling.     OccasionalAbility to climb, kneel, crouch & / or operate foot controls.     OccasionalUse a computer / other technology.     FrequentSit with the ability to vary / adjust physical position or activity.     FrequentMaintain a safe working environment & use available personal protective equipment (PPE).     ContinuousComply with Trinity Health’s Code of Conduct, policies, procedures & guidelines.     ContinuousAbility 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.     FrequentLift a maximum of 30 pounds unassisted.     OccasionalUse upper & lower extremities, engage in bending /   stooping /   reaching & pushing /   pulling.     OccasionalWork indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. ContinuousEncounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.   ContinuousPerform 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.     FrequentLift a maximum of 30 pounds unassisted.     OccasionalExperience of long periods of walking /   standing /   stooping /   bending /   pulling & /   or pushing.   OccasionalEncounter a clinical /   patient facing / hands on interactive work environment.     OccasionalWork indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.     ContinuousWork 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.