REMOTE Revenue and CDM Optimization Liaison

Trinity Health•Livonia, MI

22h•Remote

About The Position

This is a full-time, remote position responsible for the data capture, analysis, and reporting of information to assist the Trinity Health leadership team in achieving operational efficiency. The role involves auditing department information, producing reports, and suggesting process improvements. The liaison will provide expertise in the program, services, and applications, guiding and educating on correct charge capture, billing, and coding processes, as well as local, state, and federal guidelines. Responsibilities include examining and recommending improvements for departmental charge activities to ensure compliance with management plans and policies, conducting special reviews to detect fraud and develop prevention controls, and reviewing regulatory and payer changes to ensure correct charging and billing. The role also coordinates pricing increases as directed by Finance and utilizes strategic pricing applications to maximize payments within hospital budget requirements.

Requirements

Bachelor's degree in healthcare or business administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education & experience.
Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.
Must possess a demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging processes & audits & clinical billing.
Working knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to charge documentation, capture & billing is required.
Knowledge of Ambulatory Payment Classification (APC) & Outpatient Prospective Payment System (OPPS) reimbursement structures & prebill edits including Outpatient Coding Edits (OCE) / Correct Coding Initiative (CCI) edits & Discharged Note Final Billed (DNFB).

Nice To Haves

Experience with CDM oversight strongly preferred.
RHIA, RHIT, CCS, CPC / COC or other coding credentials strongly preferred.
CDC (Healthcare Compliance Certification) and CHRI (Certificate in Healthcare Revenue Integrity) are strongly preferred.

Responsibilities

Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency.
Responsible for auditing department information, producing reports, & suggesting improvements to processes.
Provides knowledge & expertise in the program, services & applications.
Guides, communicates & educates on correct charge capture, billing & coding processes & local, state & federal guidelines.
Examines, reports & makes recommendations regarding departmental charge activities for compliance with management plans & policies.
Conducts special reviews for management to discover mechanics of detected fraud & to develop controls for fraud prevention.
Reviews bulletins to maintain an understanding of regulatory & payer changes to assure correct charging & billing.
Coordinates pricing increases as directed by Finance & utilizes strategic pricing applications to maximize payments within the hospital budget requirements.