Revenue Integrity Charge Representative

Revenue Integrity Charge Specialist

Responsible for ensuring accurate CPT and/or ICD-10 documentation for the patient billing process and educating colleagues and providers in accurately document services performed and using the appropriate codes representing those services. Maintains documentation regarding charge capture processes. Performs regular reviews of process adherence and identify missing charges. Coordinates with key stakeholders regarding impacts of system change requests and upgrades to processes to ensure capture accuracy. Provides oversight of charge reconciliation processes for assigned departments; ensuring daily and appropriate monthly reconciliations are occurring.

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.

Minimum Requirements

1.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 or associate degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.

2. 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.

3. Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations.

4. Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials and/or Licensed Vocational Nurse/ Licensed Practical Nurse licensure is required. CHC (Healthcare Compliance Certification) preferred. CHRI certification/membership strongly preferred.

5. Must possess a demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing. Strong understanding of various medical claim formats.

6. Knowledge of clinical documentation improvement processes strongly preferred.

7. Strong knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

8. Ability to perform charge capture processes, including understanding technical integration of electronic medical record and the automation of charge triggers, and ability to investigate charge errors accordingly. Epic experience desired.

9. Experience and knowledge of working on appeals for insurance denials and identifying root cause.

10. Knowledge of Hospital and/or Physician group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge related errors.

11. Ability to organize and to prioritize work in a diverse, fast-paced environment while working on multiple projects simultaneously.

12. Strong problem-solving skills, analytical abilities, excellent interpersonal, verbal, and written communication skills. Ability to communicate effectively with other departments, including leadership, for the areas of charge capture, HIM, PBS, and other key stakeholders.

13. Knowledge of billing and regulatory guidelines as 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.

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

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.