Clinical Revenue Specialist
About The Position
At TriHealth, you’ll join a mission‑driven health system where your expertise directly strengthens the financial integrity that supports exceptional patient care. We foster a culture built on collaboration, accuracy, and ethical practice, giving you the opportunity to work closely with clinical teams, Revenue Integrity, Internal Charge Audit, IT, billing, and purchasing. Your work ensures compliant charge capture, optimized reimbursement, and the operational excellence that keeps our hospitals strong. TriHealth is committed to your growth, offering opportunities to expand your skills in CDM management, revenue cycle operations, and EPIC conversion initiatives as our system continues to evolve. You’ll be part of an innovative, supportive environment that values your contributions, invests in your development, and empowers you to help shape the future of healthcare operations. Apply today and grow your career with a team that truly values you. Job Overview: This position will review assigned hospital services annually to support formulation of pricing strategies and monitor pricing and charge capture for TriHealth hospitals in conjunction with the Revenue Integrity and Internal Charge Audit departments. The Clinical Revenue Specialist will also perform pre-billing financial audits of medical record documentation by comparing the documentation to detailed hospital account transactions. Detailed findings of charge error trends will be reported to clinical department management. This position acts as a liaison for hospital charge capture to clinical teams, charge entry team members, IT, billing, and purchasing. CDMs (charge description master) will be maintained with current and accurate revenue codes, CPT/HCPCS codes along with standardized descriptions and billing categories. This position will lead revenue cycle functions for CDM conversions to EPIC for any new acquired hospital-based entities.
Requirements
- Associate’s degree or Diploma in Healthcare
- An associate degree in healthcare, finance or coding or nursing or a diploma in nursing is minimum education requirement
- An overall understanding of hospital charging/billing and reimbursement methodologies which includes understanding of CPT/HCPCS code sets Strong Microsoft Office Excel skills
- 3-4 years’ experience Professional Healthcare
Responsibilities
- Maintains accurate and compliant CDM.
- Regularly reviews vendor CDM compliance reports for assigned service areas and hospital locations and takes necessary action to maximize compliant billing and reimbursement.
- Actively reviews and resolves revenue guardian checks, claim edits, and work queues as assigned.
- These revenue validation tools ensure accurate, timely billing and accurate reimbursement.
- Performs pre-billing financial audits of medical record documentation by comparing the documentation to detailed hospital account transactions.
- Monitors charge capture processes and assist clinical departments, Revenue Integrity and Internal Charge Audit to ensure timely and accurate hospital charge capture.
Benefits
- TriHealth offers a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page https://careers.trihealth.com/what-we-offer/benefits [https://careers.trihealth.com/what-we-offer/benefits]
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
1,001-5,000 employees
