Work Type: Complete time
Shift:
Description:
POSITION FUNCTION- REMOTE
Accountable for examining all post-billed rejections (inclusive of coding-related rejections) for coding precision and appealing them based upon coding competence and coding judgment within the Medical facility and/or Medical Group income operations ($ 3-5B NPR) of a Client Company Solutions (PBS). Acts as part of a group of coding payment resolution associates at a PBS area accountable for determining and identifying source of rejections. Accountable for leveraging coding understanding and guidelines to track appeals through initially, 2nd, and subsequent levels, and guaranteeing prompt filing of appeals as needed by payers. in addition to promoting department awareness of coding finest practices. This position reports straight to the Manager Clinical/Coding Payment Resolution.
IMPORTANT FUNCTIONS
Understands, comprehends, integrates, and shows the Trinity Health Objective, Vision, and Worths in habits, practices, and choices.
Supplies comprehensive understanding or ability for dealing with 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 upon medical record evaluations, agreements, guidelines as directed by the Manager Medical/ Coding Payment Resolution.
Translates information, reasons, and examines findings with all level of Payment Resolution Expert for additional evaluation.
Takes effort to continually discover all elements of Payment Resolution Professional function to support progressive obligation.
Other responsibilities as required and designated by the Manager Medical/ Coding Payment Resolution.
Keeps a working understanding of suitable Federal, State and regional laws/regulations; the Trinity Health Stability and Compliance Program and Standard Procedure; along with other policies and treatments in order to guarantee adherence in a way that shows truthful, ethical and expert habits.
MINIMUM CREDENTIALS
High school diploma or Associate degree in Accounting or Service Administration or associated field, and a minimum of 4 (4) years’ experience within a medical facility or center environment, a medical insurance business, handled care company or other healthcare monetary service setting, carrying out medical claims processing, monetary therapy, monetary clearance, accounting or client service activities or a comparable mix of education and experience. Experience in a complex, multi-site environment chosen.
Needs to have detailed understanding of professional/physician diagnostic and procedural coding, as generally gotten 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 pertinent health center inpatient coding experience consisting of DRG project.
Should be a Registered Health Info Administrator (RHIA), Registered Health Details Professional (RHIT), or coding credential of a Licensed Coding Expert (CCS) or Licensed Expert Coder (CPC).
Needs to have experience with National Correct Coding Effort modifies (NCCI), National Protection Decisions (NCD), Regional Protection Decisions (LCD), and Outpatient coding standards for main coding and reporting.
Has in-depth understanding of concepts, approaches, and methods connected to certified health care billing/collections.
Has knowledge in medical terms, illness procedures, client health record material and the medical record coding procedure.
Needs to be comfy operating in a collective, shared management environment.
Needs to have an individual existence that is identified by a sense of sincerity, stability, and caring with the capability to influence and encourage others to promote the approach, objective, vision, objectives, and worths of Trinity Health.
PHYSICAL AND PSYCHOLOGICAL REQUIREMENTS AND WORKING CONDITIONS
This position runs in a common workplace environment. The location is well lit, temperature level managed and devoid of risks.
Incumbent interacts regularly, personally and over the phone, with individuals in all areas on item assistance problems.
Manual mastery is required to run a keyboard. Hearing is required for substantial telephone and face to face interaction.
The environment in which the incumbent will work needs the capability to focus, fulfill due dates, deal with a number of tasks at the very same time and adjust to disturbances.
Needs to have the ability to set and arrange own work concerns and adjust to them as they alter often. Should have the ability to work simultaneously on a range of tasks/projects in an environment that might be difficult with people having varied characters and work designs.
Should have the capability to adhere to Trinity Health policies and treatments.
Trinity Health’s Dedication to Variety and Addition
Trinity Health utilizes about 133,000 coworkers at lots of medical facilities and numerous university hospital in 22 states. Since we serve varied populations, our coworkers are trained to acknowledge the cultural beliefs, worths, customs, language choices, and health practices of the neighborhoods that we serve and to use that understanding to produce favorable health results. We likewise acknowledge that each people has a various mindset and viewing our world which these distinctions typically result in ingenious services.
Trinity Health’s commitment to variety consists of a unified labor force (through training and education, recruitment, retention and advancement), dedication and responsibility, interaction, neighborhood collaborations, and provider variety.
Trinity Health.
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