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Description:

JOB SUMMARY

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.

• 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. 
• 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.
• Communicates and follows-up with designated Utilization Review staff regarding clinical denials. 
• Performs other duties consistent with purpose of job as directed.

JOB SPECIFICATIONS AND CORE COMPETENCIES

Education:   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.

Licensure:  RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.

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.

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.