Revenue Integrity Coordinator

Trinity Health

10d

About The Position

The Revenue Integrity Coordinator performs in-depth analysis of patient clinical and billing data to identify documentation, coding, and denial-prevention opportunities. The role develops and implements denial-prevention action plans based on root-cause analysis, supports revenue-cycle efficiency and data integrity, and helps ensure compliance with billing and regulatory guidelines. The position is divided equally between operations and support for front-end eligibility and denials. The coordinator works with clinical areas to improve documentation of services and understanding of medical necessity, coding, and charging. The role performs audits, coordinates complex denials and appeals, reports findings and trends, provides education, and partners with clinical, finance, compliance, payer, and revenue-cycle teams to address root causes and improve processes. Travel between locations within the Region may be required, up to 25%. The position operates in a typical office environment that is well lit, temperature controlled, and free from hazards. It involves frequent in-person and telephone communication, keyboard use, concentration, deadline management, and handling multiple concurrent projects and interruptions. Work may be fast-paced and stressful, and varied or extended hours may be warranted as workload and priorities change. The organization describes itself as mission-driven and committed to improving community health, honoring each person’s dignity, embracing differences, and providing compassionate, person-centered care. It is an Equal Opportunity Employer.

Requirements

Bachelor’s degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of education and experience.
Five or more years of experience in billing, charge documentation, charge audit, charge capture, or other revenue-cycle activities.
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.
Working knowledge of third-party payer rules and requirements, computer operations, and electronic interfaces related to charge documentation, capture, and billing.
Knowledge of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures and pre-bill edits, including Outpatient Coding Edits (OCE), Correct Coding Initiative (CCI) edits, and Discharged Note Final Billed (DNFB).
Experience with post-payment audits and coding, clinical, and technical denials.
Strong analytical, organizational, prioritization, accuracy, attention-to-detail, and time-management skills, including the ability to manage multiple responsibilities and projects.
Excellent interpersonal, verbal, and written communication abilities.
Ability to work collaboratively in a shared-leadership environment and with people with diverse personalities and work styles.
Ability to concentrate, meet deadlines, adapt to interruptions and changing priorities, and work in a fast-paced, potentially stressful, multi-customer environment.
Ability to comply with Trinity Health policies and procedures.
Ability to travel between locations within the Region, up to 25% as required.

Nice To Haves

Proficiency with MS Excel, Access, and Business Objects is highly desired; strong competency with Word and PowerPoint.
RHIA, RHIT, CCS, CPC/COC, or other coding credentials are strongly preferred.
CDC (Healthcare Compliance Certification) is preferred.

Responsibilities

Collaborate with departmental teams on denial investigations and root-cause analysis, identifying opportunities for prevention across the revenue cycle.
Analyze data and report trends, performance metrics, process improvements, and revenue impact.
Perform revenue optimization activities, including education, process improvement, ongoing assessment, and resolution of root-cause issues; assist the centralized charge control team when needed.
Conduct departmental audits for proper documentation and compliance with state and federal charge-capture and billing guidelines; submit findings and recommendations and work with leaders to implement solutions.
Collaborate with clinical departments, the Patient Business Service (PBS) center, Payer Strategies, Compliance, and other revenue-cycle departments on denial coordination, denial prevention, and pre-bill edit prevention.
Work with Revenue Liaisons and/or physician operational leaders on system implementations, enhancements, and new service-line requests to support revenue-cycle integrity and compliance.
Work with ancillary teams and providers to develop processes to prevent future denials.
Track potential risk accounts with leadership and review them with Finance to assess impacts to reserves in the Bad Debt Charity Operational write-offs (BCO) model.
Attend meetings with payer representatives and/or vendors to address outstanding issues and stay informed about regulations or guidelines; attend monthly denial-management meetings at individual ministries.
Coordinate denials, appeals, and reconsideration requests involving clinical, coding, and technical denials with the PBS center, including outpatient RAC denials and appeals as applicable.
Maintain denial and appeal logs and assessments in accordance with applicable guidelines.
Monitor regulatory and payer changes and maintain current knowledge of payer policies, billing requirements, and coding regulations to support accurate, compliant charging and billing.
Complete assigned reports accurately and on time, and perform other duties as assigned.
Maintain knowledge of applicable laws, regulations, the Trinity Health Integrity and Compliance Program, Code of Conduct, and organizational policies and procedures.
Demonstrate Trinity Health’s Mission, Vision, and Values in work behaviors, practices, and decisions.