Revenue Integrity Recovery Coordinator

Trinity Health•Livonia, MI

4d•$25 - $38•Remote

About The Position

The Revenue Integrity Recovery Coordinator performs in-depth analysis of patient clinical and billing data to identify documentation, coding, and denial-prevention opportunities. The coordinator develops and implements denial-prevention action plans based on root cause analysis, supports revenue cycle efficiency and data integrity, and promotes compliance with billing and regulatory requirements. The position coordinates complex denials with team members and collaborates across departments on audits, education, charge capture accuracy, and revenue cycle process improvements. It works closely with clinical areas to support accurate documentation of services and understanding of the relationship among documentation, medical necessity, coding, and charging. Assigned reports must be completed accurately and on time. Travel between locations within the region may be required. This is a 100% remote position. The role may assist the centralized charge control team, coordinate coding and technical denials and reconsideration requests, maintain denial and audit records, monitor regulatory and payer changes, and work with leadership and Finance on potential risk accounts. The coordinator also participates in payer and vendor meetings and monthly denial management meetings at individual ministries.

Requirements

Demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (including CPT, HCPCS, ICD-9/10, revenue codes, and modifiers), charging processes and audits, and clinical billing, ordinarily obtained through a 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 or charge capture activities, or other revenue cycle-related functions.
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), 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.
Ability to work in a potentially stressful environment with individuals who have diverse personalities and work styles.
Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
Excellent interpersonal, verbal, and written communication skills; accuracy, strong analytical skills, attention to detail, and time management skills.
Comfort operating in a collaborative, shared leadership environment.
Honesty, integrity, caring, and the ability to inspire and motivate others to promote Trinity Health’s philosophy, mission, vision, goals, and values.
Strong competency with Word and PowerPoint.

Nice To Haves

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

Responsibilities

Demonstrate Trinity Health’s Mission, Vision, and Values in behavior, practices, and decisions.
Collaborate with the intra-departmental team on denial investigations and root cause analysis, identifying denial-prevention opportunities throughout the revenue cycle.
Analyze data and report trends, performance metrics, process improvements, and revenue impact.
Conduct 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 to ensure proper documentation and compliance with state and federal charge-capture and billing guidelines.
Prepare and submit audit findings, make recommendations, and work with revenue integrity leadership and inter-departmental 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 that prevent future denials.
Work with leadership to track potential risk accounts and review them with Finance for potential impacts to reserves in the Bad Debt Charity Operational write-offs (BCO) model.
Attend payer representative and/or vendor meetings to address outstanding issues or learn about new regulations and guidelines; attend monthly denial management meetings at individual ministries.
Coordinate coding and technical denials, audits, and reconsideration requests with the PBS center, potentially including outpatient RAC denials and audits.
Maintain denial and audit logs and assessments in accordance with applicable guidelines.
Maintain knowledge of regulatory and payer changes, coding and billing regulations, local payer policies, and procedures to support accurate charging, billing, compliance, and optimization.
Complete other assigned duties.
Maintain working knowledge of applicable laws, regulations, the Trinity Health Integrity and Compliance Program and Code of Conduct, and other policies and procedures; adhere to honest, ethical, and professional conduct.