POSITION SUMMARY
Responsible for maintaining documentation regarding charge capture processes including technology components and personnel interactions to allow for organizational clarity & accountability. Performs regular reviews of process adherence and identifies missing charges. Works with other key stakeholders regarding impacts of system change requests and upgrades on charging processes to ensure continued capture accuracy. Provides oversight of reconciliation processes for all assigned departments; ensuring daily and appropriate monthly reconciliations are occurring. Handles charge entry, charge approvals, and/or charge reviews for identified service lines including but not limited to, appending modifiers, and checking clinical documentation.
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.1.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Review's chart, including nursing notes, physician orders and progress notes thoroughly to interpret and validate and/or extract all charges. Ensures each chart is complete according to specified guidelines. Ensures charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers.
May performs or provide “at elbow” guidance to clinical departmental daily reconciliation processes including 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.
Review's documentation, abstract data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines.
Reviews charge capture lags and charge error management and ensures timely attention to departmental assigned charge errors. Reports repetitive charge discrepancies to leadership.
Compares charges to clinical/medical record documentation while ensuring compliance and regulatory requirements are met. Educates clinical staff or other stakeholders on need for accurate and complete documentation to ensure revenue optimization and integrity.
Maintains a minimum productivity standard, based on service line and charge type including but not limited to chart review, charge extraction, E&M level assignment and charge entry.
Documents lessons learned and provided feedback to Revenue Integrity department to create standard charge capture and process reference materials. Assists with project initiatives to deploy information and provide education.
Reviews and respond to various quality reports, including reports that identify missing charges, duplicate charges, late charges, etc. Maintain and update required reference logs and other reporting tools. May create and present information for decision making purposes.
Attends coding and reimbursement workshops and webinars; communicates related information to appropriate departments and ensures understanding and assists with applicable process or system changes as needed.
May perform research on charges and communicate findings to intra and inter-departmental colleagues.
Other duties, as assigned.
MINIMUM QUALIFICATIONS
Licensure/Certification: High school diploma or equivalent combination of education and experience. RHIA, RHIT, CCS, CPC/COC, AAPC or other coding credentials and/or Licensed Vocational Nurse/Licensed Practical Nurse licensure preferred. CHC (Healthcare Compliance Certification) preferred. CHRI certification/membership strongly preferred.
Minimum of one (1) to two (2) years of relevant work experience in a hospital and/or Physician Practice environment and experience in revenue cycle, billing, coding and/or patient financial services. Charge control/capture work experience strongly preferred.
Knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.
Knowledge of Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration that may impact charge related errors.
Ability to organize and to prioritize work in a diverse, fast-paced environment while working on multiple projects simultaneously.
Knowledge of billing and regulatory guidelines related to charging and other revenue cycle processes and ability to assist clinical departments and/or physician practices with changes to their charging practices based on guidelines.
Experience with MS Excel, Word and PowerPoint preferred. Epic experience preferred.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Maintains a working knowledge of applicable Federal, State, and Local laws and regulations, the Trinity Health Integrity and Compliance Program, including the Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behaviors
PHYSICAL REQUIREMENTS
This position operates in a typical office and/or home office environment. The area is well lit, temperature controlled and free from hazards.
Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.
Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.
The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.
Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.
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.