Work Type: Full time
Shift:
Description:
POSITION FUNCTION
Accountable for evaluating all post-billed rejections (inclusive of coding-related denials) for coding precision and appealing them based upon coding know-how and coding judgment within the Hospital and/or Medical Group income operations ($ 3-5B NPR) of a Client Organization Providers (PBS). Acts as part of a team of coding payment resolution associates at a PBS location accountable for recognizing and determining origin of rejections. Responsible for leveraging coding knowledge and standard procedures to track appeals through initially, second, and subsequent levels, and making sure timely filing of appeals as required by payers. in addition to promoting department awareness of coding finest practices. This position reports straight to the Manager Clinical/Coding Payment Resolution.
VITAL FUNCTIONS
Understands, comprehends, includes, and shows the Trinity Health Objective, Vision, and Values in habits, practices, and decisions.
Offers detailed understanding or ability for fixing denials based upon ICD-10- CM diagnosis codes, ICD-10- PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, policies as directed by the Supervisor Scientific/ Coding Payment Resolution.
Translates data, draws conclusions, and reviews findings with all level of Payment Resolution Professional for further evaluation.
Takes initiative to continuously discover all elements of Payment Resolution Professional function to support progressive duty.
Other responsibilities as required and designated by the Manager Medical/ Coding Payment Resolution.
Keeps a working knowledge of applicable Federal, State and regional laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; along with other policies and treatments in order to make sure adherence in a manner that reflects honest, ethical and expert behavior.
MINIMUM CREDENTIALS
High school diploma or Associate degree in Accounting or Business Administration or related field, and a minimum of 4 (4) years’ experience within a medical facility or center environment, a health insurance company, handled care organization or other healthcare financial service setting, carrying out medical claims processing, monetary therapy, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment chosen.
Must possess thorough knowledge of professional/physician diagnostic and procedural coding, as typically obtained through a coding certificate program and least one (1) year of physician/professional or healthcare facility outpatient coding experience or minimum of 2 (2) years of relevant health center inpatient coding experience including DRG task.
Must be a Registered Health Info Administrator (RHIA), Registered Health Information Specialist (RHIT), or coding credential of a Certified Coding Professional (CCS) or Qualified Professional Coder (CPC).
Must have experience with National Correct Coding Initiative edits (NCCI), National Protection Decisions (NCD), Local Coverage Decisions (LCD), and Outpatient coding standards for main coding and reporting.
Has comprehensive understanding of principles, methods, and methods related to certified healthcare billing/collections.
Has proficiency in medical terms, illness processes, patient health record material and the medical record coding procedure.
Must be comfy operating in a collective, shared leadership environment.
Should possess a personal existence that is defined by a sense of sincerity, integrity, and caring with the capability to motivate and inspire others to promote the approach, mission, vision, objectives, and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
This position operates in a typical workplace environment. The location is well lit, temperature managed and free from risks.
Incumbent communicates regularly, personally and over the phone, with people in all areas on product assistance issues.
Manual dexterity is required to operate a keyboard. Hearing is needed for comprehensive telephone and personally interaction.
The environment in which the incumbent will work requires the capability to concentrate, fulfill due dates, work on numerous tasks at the same time and adjust to disruptions.
Must have the ability to set and arrange own work priorities and adjust to them as they change frequently. Should have the ability to work concurrently on a variety of tasks/projects in an environment that may be difficult with people having diverse characters and work styles.
Should have the ability to comply with Trinity Health policies and treatments.
Trinity Health’s Commitment to Diversity and Inclusion
Trinity Health utilizes about 133,000 colleagues at lots of health centers and numerous health centers in 22 states. Since we serve diverse populations, our colleagues are trained to acknowledge the cultural beliefs, values, traditions, language preferences, and health practices of the neighborhoods that we serve and to apply that knowledge to produce favorable health outcomes. We also acknowledge that each people has a various way of thinking and viewing our world which these distinctions often lead to ingenious solutions.
Trinity Health’s commitment to variety consists of a unified labor force (through training and education, recruitment, retention and development), commitment and accountability, communication, community collaborations, and provider variety.
Trinity Health.
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