Revenue Integrity Recovery Coordinator

Trinity Health•Livonia, MI

2d•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 role develops and implements denial-prevention action plans based on root-cause analysis and promotes revenue-cycle efficiency, data integrity, and compliance with billing and regulatory guidelines. It coordinates complex denials, performs audits, and collaborates with clinical and revenue-cycle teams to improve charge capture, documentation, coding, medical-necessity processes, and billing accuracy. The position is 100% remote and may require travel between locations within the Region. The coordinator analyzes data and reports trends, performance metrics, process improvements, and revenue impact; conducts departmental audits; submits findings and recommendations; and works with leadership and other departments to implement solutions. The role maintains denial and audit logs, coordinates coding and technical denials and reconsideration requests, monitors payer and regulatory changes, and helps ensure accurate charging and billing. It also supports system implementations, enhancements, new service lines, and other revenue-optimization activities as assigned.

Requirements

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.
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 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 and Outpatient Prospective Payment System reimbursement structures, and pre-bill edits including Outpatient Coding Edits, Correct Coding Initiative edits, and Discharged Note Final Billed.
Experience with post-payment audits and coding, clinical, and technical denials.
Proficiency with Microsoft Excel, Access, and Business Objects is highly desired; strong competency with Word and PowerPoint.
Ability to work in a potentially stressful environment with individuals having 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.
Ability to work in a collaborative, shared-leadership environment.
Personal presence characterized by honesty, integrity, and caring, with the ability to inspire and motivate others in support of Trinity Health's philosophy, mission, vision, goals, and values.

Nice To Haves

RHIA, RHIT, CCS, CPC/COC, or other coding credentials.
CDC (Healthcare Compliance Certification) or CHRI.

Responsibilities

Collaborate with intra-departmental teams on denial investigations and root-cause analysis, identifying denial-prevention opportunities across the revenue cycle.
Analyze data and report trends, performance metrics, process improvements, and impacts to revenue.
Perform revenue-optimization activities, including education, process improvement, ongoing assessment, and resolution of root-cause issues.
Assist the centralized charge control team when necessary.
Conduct departmental audits to assess documentation and compliance with state and federal charge-capture and billing guidelines.
Prepare and submit audit findings and recommendations, and work with revenue-integrity and interdepartmental leaders to implement solutions.
Collaborate with clinical departments, the Patient Business Service center, Payer Strategies, Compliance, and other revenue-cycle departments on denial coordination and prevention, including 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 model.
Attend meetings with payer representatives and/or vendors to address outstanding issues and remain informed about regulations and guidelines.
Attend monthly denial-management meetings at individual ministries.
Coordinate denials, audits, and reconsideration requests related to coding and technical denials with the Patient Business Service center, potentially including outpatient RAC denials and audits.
Maintain denial and/or audit logs and assessments in accordance with applicable guidelines.
Maintain knowledge of coding, billing, regulatory, and payer requirements, including local payer policies and procedures.
Complete assigned reports accurately and on time, and perform other duties as assigned.
Follow applicable laws, regulations, the Trinity Health Integrity and Compliance Program, the Code of Conduct, and other policies and procedures.