This role is within the Integrity and Compliance department of IAS in the professional services Center of Excellence, providing support for the seven elements of an effective compliance program. This role is primarily responsible for the functions of coding, auditing, monitoring, and education delivery efforts for professional services which relies on a thorough understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing Manual, National Correct Coding Initiatives, current procedural terminology, and International Classification of Diseases coding guidelines.
Position Purpose: Applies credentialed subject matter expertise in field of professional coding, documentation, claims submission and reimbursement policies as required by state and federal payers to conduct auditing and monitoring of health ministries. Responsibilities include assisting in the completing scheduled work plan reviews, as well as assist in conducting research, investigations, and defense activities in response to inquiries from Ministries, Medicare, Office of Inspector General, Department of Justice or other programs. Assists in interpreting, disseminating, and educating Trinity Health Ministries with federal policy changes, and other pertinent regulatory updates as they occur.
Purpose
Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing of department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications.
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.
MINIMUM QUALIFICATIONS
1. Must possess at least one of the following licenses/certifications: CPC, CCS-P, RHIT, RHIA, RN, PT, OT or professional certification in another healthcare field (as appropriate for the subject matter assigned to audit) as normally obtained through a degree program or an equivalent knowledge base and a minimum of three (3) years’ experience in a health care setting. The minimum of an associate’s degree is required, Bachelors preferred.
2. Additional coding certification through either AHIMA or AAPC or equivalent knowledge base is preferred.
3. Must have an in-depth knowledge of Medicare and Medicaid documentation, coding, and billing regulations for applicable service lines(s) assigned, in addition to CMS Conditions of Participation. Additional knowledge of other third-party payer requirements for documentation, coding and billing preferred.
4. Must exhibit behaviors that contribute toward a collaborative, supportive, shared leadership environment
Hourly pay ranges: $26.87 - $40.32
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 safe, honest, ethical & professional behavior & safe work practices.
Additional Qualifications (nice to have)
Possess and maintain licensure or certification in compliance, law, audit, privacy, healthcare, or other relevant field or area of study. Experience with government audits, inquiries, investigations, response, and mitigation.
Master's or professional degree in law, business or health care preferred.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.