Revenue Integrity Charge Specialist

Employment Type: Full time Shift: Description: 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 Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice. Review's chart, including nursing notes, physician orders, progress notes, and surgical or specialty 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. Review's documentation, abstracts data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer regulations. Performs coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review Responsible for proofing daily charges for accuracy and clean claim submission Responsible for balancing charges and adjustments Maintains productivity standards Maintains compliance with regulatory requirements Assist Nurse Auditor and/or Coordinator with denial coordination process; including analysis of clinical documentation, root cause analysis and tracking as needed. Educates clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity. Performs outpatient clinical documentation improvement review (acute only) as needed. Performs research on charges and communicate findings to intra and inter-departmental colleagues, as needed. 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 works with colleagues in Revenue Integrity department on creating standard charge capture and process reference materials. Assists with project initiatives to deploy information and provides education to departmental colleagues. Reviews and responds 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 develop and present information. As needed, performs daily reconciliation processes and/or provides “at-elbow support” to ancillary departments including, but not limited to; 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. Maintains patient confidentiality. Other duties as assigned. 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. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.