Revenue Integrity Specialist

Employment Type:

Full time

Shift:

Description:

Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and collaborates with intra-departmental team members to identify root cause. Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately. May be required to travel between locations within the Region.

***EPIC A PLUS

Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.

Very strong Billing / Acute background

Exp. with Denials

Exp. with Hosptial Claims a must!

• Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of years of education and experience.

• Three (3) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.

• Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.

• Working knowledge of third party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.

• Must possess a demonstrated knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing.

• Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

• Must be able to work in an environment that may be stressful with a variety of individuals having diverse personalities and work styles.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran