Revenue Integrity Account Specialist

Trinity Health

1d•Remote

About The Position

Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. With its main campus at Loyola University Medical Center, Loyola Medicine is part of a comprehensive three-hospital system including Loyola University Medical Center, Gottlieb Memorial Hospital, and MacNeal Hospital. If you’re passionate about delivering exceptional care and making a difference in the lives of our communities, join the Loyola team and become Loyola Strong! This position is 100% remote. The Revenue Cycle Analyst analyzes patient clinical and billing data to identify opportunities to improve documentation, coding accuracy, and charge capture. This role resolves pre-bill edits, performs root cause analysis, and partners with cross-functional teams to optimize revenue cycle performance. This position supports compliance, documentation improvement, and revenue cycle outcomes through audits, reporting, and education. Works closely with clinical teams to ensure accurate documentation aligned with medical necessity, coding, and billing requirements. May require occasional regional travel.

Requirements

Associate’s or Bachelor’s degree in Healthcare Administration, Business, Finance, Accounting, Nursing, or a related field
Minimum of 3 years of experience in revenue cycle operations, including billing, charge capture, auditing, or related functions
Strong understanding of: Clinical workflows and documentation processes
Strong understanding of: Charge master maintenance and charge capture
Strong understanding of: Medical coding systems (CPT, HCPCS, ICD-10, revenue codes, modifiers)
Strong understanding of: Billing and reimbursement methodologies
Strong understanding of: Revenue cycle processes, including audits and reconciliation
Familiarity with: APC and OPPS reimbursement structures
Familiarity with: Pre-bill edits (OCE, CCI) and DNFB workflows
Familiarity with: Knowledge of third-party payer regulations and requirements
Advanced proficiency in Microsoft Excel; experience with Access and Business Objects preferred; strong skills in Word and PowerPoint
Excellent analytical, organizational, and problem-solving abilities
Strong interpersonal, written, and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment

Nice To Haves

One or more of the following certifications preferred: RHIA, RHIT, CCS CPC/COC (AAPC)
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)
Certified in Healthcare Compliance (CHC/CDC preferred)
CHRI certification or membership strongly preferred

Responsibilities

Resolve pre-bill edits (OCE/CCI, claim scrubber edits, DNFB) within established timelines
Analyze data to identify documentation, coding, and charge capture opportunities
Conduct root cause analysis and support denial prevention efforts
Partner with clinical teams to ensure accurate documentation and billing alignment
Stay current on payer requirements and regulatory changes
Collaborate with Patient Business Services (PBS) on payer requests and claims
Support revenue optimization and charge control initiatives
Prepare timely, accurate reports
Ensure compliance with all applicable regulations and policies
Perform other duties as assigned