Revenue Integrity Coding Specialist - CPC Required

Employment Type: Full time Shift: Day Shift Description: Job Description Summary This is a M-F, 8a-5p remote position that requires certification. For the Holy Cross Medical Group this individual performs charge entry, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers and checking clinical documentation. Works closely with Revenue Integrity staff and providers to educate on improved documentation to support coding. Neurosurgery experience is highly preferred. CPC license is REQUIRED. What you will do: Responsible for coding and/or validation of charges for more complex service lines, advanced proficiencies in surgical or specialty coding practice. Review chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges. Ensure each chart is complete according to specified guidelines. Ensure charges captured on the correct patient, correct encounter, correct date of service, with any required modifiers. Review documentation, abstracts data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines. Ensure medical documentation and coding compliance with Federal, State and Private payer regulations. a. Perform coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review b. Responsible for proofing daily charges for accuracy and clean claim submission c. Responsible for balancing charges and adjustments d. Maintain productivity standards e. Maintain compliance with regulatory requirements Responsible for denial coordination with Patient Business Service (PBS) centers, including analysis of clinical documentation, assisting in appeals, root cause analysis and tracking as needed. 6. Educates clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity. Educate clinical staff on need for accurate and complete documentation to ensure revenue optimization and integrity. Perform outpatient clinical documentation improvement review (acute only) as needed. Perform research on charges and communicate findings to intra and inter-departmental colleagues. Maintain 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. Other related responsibilities as assigned by manager. Minimum Qualifications: High school diploma or equivalent combination of education and experience. 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. Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or Medical Group practice operations. Licensure / Certification: CPC license required. Neurosurgery experience preferred 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. Knowledge of clinical documentation improvement processes strongly preferred. Strong knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre-bill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). 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. Position Highlights and Benefits: Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance. Comprehensive benefits that start on your first day of work Retirement savings program with employer matching We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners. Ministry/Facility Information: A member of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation, Fort Lauderdale-based Holy Cross Hospital, dba Holy Cross Health, is a full-service, not-for-profit, Catholic, teaching hospital operating in the spirit of the Sisters of Mercy. We are the only not-for-profit Catholic hospital in Broward and Palm Beach counties. Through strategic collaborations and a commitment to being a person-centered, transforming, healing presence, the 557-bed hospital offers progressive inpatient, outpatient and community outreach services and clinical research trials to serve as our community’s trusted health partner for life. We are committed to providing compassionate and holistic person-centered care. Legal Info: We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local 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.