Employment Type: Full time
Shift:
Description:
POSITION FUNCTION
Responsible for examining all post-billed rejections (inclusive of coding-related denials) for coding precision and appealing them based upon coding proficiency and coding judgment within the Health center and/or Medical Group profits operations ($ 3-5B NPR) of a Patient Business Providers (PBS). Functions as part of a team of coding payment resolution associates at a PBS area accountable for determining and identifying source of denials. Accountable for leveraging coding understanding and standard operating procedures to track appeals through initially, second, and subsequent levels, and ensuring timely filing of appeals as needed by payers. in addition to promoting departmental awareness of coding finest practices. This position reports straight to the Manager Clinical/Coding Payment Resolution.
ESSENTIAL FUNCTIONS
Knows, comprehends, incorporates, and shows the Trinity Health Mission, Vision, and Worths in behaviors, practices, and decisions.
Offers in-depth understanding or ability for fixing rejections based upon ICD-10- CM medical diagnosis codes, ICD-10- PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding factors and processing charge corrections based on medical record reviews, contracts, policies as directed by the Supervisor Medical/ Coding Payment Resolution.
Analyzes data, draws conclusions, and reviews findings with all level of Payment Resolution Specialist for more evaluation.
Takes effort to continually learn all elements of Payment Resolution Professional function to support progressive obligation.
Other responsibilities as required and appointed by the Supervisor Medical/ Coding Payment Resolution.
Preserves a working knowledge of suitable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Standard Procedure; as well as other policies and procedures in order to guarantee adherence in a way that reflects sincere, ethical and professional habits.
MINIMUM CREDENTIALS
High school diploma or Associate degree in Accounting or Business Administration or associated field, and a minimum of 4 (4) years’ experience within a health center or clinic environment, a health insurance business, managed care company or other health care monetary service setting, performing medical claims processing, monetary therapy, monetary clearance, accounting or customer care activities or an equivalent mix of education and experience. Experience in a complex, multi-site environment chosen.
Needs to possess detailed understanding of professional/physician diagnostic and procedural coding, as usually acquired through a coding certificate program and least one (1) year of physician/professional or health center outpatient coding experience or minimum of two (2) years of appropriate hospital inpatient coding experience including DRG task.
Needs To be a Registered Health Details Administrator (RHIA), Registered Health Information Specialist (RHIT), or coding credential of a Qualified Coding Specialist (CCS) or Qualified Professional Coder (CPC).
Should have experience with National Correct Coding Initiative modifies (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding standards for main coding and reporting.
Has detailed understanding of concepts, methods, and methods associated with certified healthcare billing/collections.
Possesses know-how in medical terms, illness processes, client health record content and the medical record coding procedure.
Needs to be comfortable operating in a collective, shared management environment.
Must have a personal presence that is defined by a sense of sincerity, integrity, and caring with the capability to influence and inspire others to promote the philosophy, mission, vision, goals, and worths of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
This position operates in a typical office environment. The area is well lit, temperature controlled and free from dangers.
Incumbent communicates regularly, in person and over the phone, with individuals in all locations on product assistance problems.
Manual mastery is needed to run a keyboard. Hearing is required for substantial telephone and personally interaction.
The environment in which the incumbent will work requires the capability to concentrate, fulfill due dates, deal with numerous projects at the exact same time and adjust to disruptions.
Must have the ability to set and organize own work top priorities and adapt to them as they change regularly. Must have the ability to work simultaneously on a range of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Needs to have the capability to comply with Trinity Health policies and treatments.
Trinity Health’s Dedication to Diversity and Addition
Trinity Health utilizes about 133,000 colleagues at lots of medical facilities and hundreds of health centers in 22 states. Due to the fact that we serve varied populations, our associates are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to use that knowledge to produce positive health results. We likewise recognize that each of us has a different point of view and viewing our world which these distinctions frequently cause ingenious solutions.
Trinity Health’s dedication to diversity consists of a unified workforce (through training and education, recruitment, retention and development), commitment and responsibility, interaction, community collaborations, and supplier diversity.
Trinity Health.
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