This is a REMOTE position.
Provides high level technical competency and subject matter expertise analyzing charge review
errors and claim edits for complex services, including code selection of surgical procedures, and
assessment of high-acuity type services. Ensures correct charge capture and coding with
proper CPT, HCPCS, and ICD-10 codes, as well as proper modifiers, adhering to local ministry
and Trinity Health practices and policies. Analyzes medical documentation verifying diagnoses,
assigning diagnostic codes, selecting simple and complex surgical/procedural codes, and
modifiers using coding guidelines established by the Centers for Medicare and Medicaid
Services (CMS), performing charge entry, and charge capture reconciliation and discrepancy
resolution as required. Serves as a liaison between other Centralized Coding positions in
Revenue Site Operations and physicians/ clinical sites/departments. Interprets, researches and
resolves issues and problems that arise.
ESSENTIAL FUNCTIONS
1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
2. Performs coding for hospital-based surgeries, inpatient and outpatient, identified by a TC Epic surgical placeholder. Communicates with provider if additional information is needed to complete the surgical coding.
3. Interprets and resolves charge review and claim edit errors for provider coded services, including, but not limited to surgical, high acuity, critical care, and other complex service lines of business.
4. Responsible for reviewing clinical documentation to determine accurate ICD-10, CPT, HCPCS, and modifier assignment.
5. Research all information needed to complete coding process. Reaches out to provider if additional clarification is needed to support or missing coded services.
6. Adheres to coding quality and productivity standards as established by Revenue Excellence; maintains accuracy of 95% or greater per coding audits.
7. Responsible for charge capture reconciliation and discrepancy resolution for assigned department, services, and/or providers.
8. Identifies and facilitates additional review of services as needed by Regional Certified Coding leadership.
9. Adheres to and follows daily, weekly & monthly productivity requirements.
10. Resolves coding discrepancies related to coding and revenue capture.
11. Participates in the liaison process between the Centralized Coding, Providers, Managers, and Leadership which includes support for Coder knowledge and learning.
12. Maintains relevant education to perform essential functions and keeps coding credentials (i.e., CPC, CCS-P, RHIT, or equivalent accreditation) up to date. Maintains CEUs as appropriate for coding credentials as required by credentialing organizations and in order to maintain current knowledge of coding guidelines and regulations.
13. Serves as a resource for providers, managers, peers.
14. Other duties as needed and assigned by the manager.
15. Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
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.