Revenue Protection Specialist

Trinity Health • Livonia, MI

19h • Onsite

About The Position

This role is responsible for researching, collecting, and analyzing information to identify opportunities and develop solutions for revenue protection. The specialist will collaborate on performance improvement activities, distribute analytical reports, and utilize multiple system applications for analysis and report creation. A key focus is on maintaining quality, confidentiality, and safety by understanding Trinity Health policies, practices, and processes. The role involves managing and analyzing data to support operational projects, synthesizing data to provide summaries and recommendations, and leveraging program data to demonstrate progress and ROI. Maintaining knowledge of applicable laws, regulations, and the Trinity Health Integrity & Compliance Program is essential. The specialist will develop, monitor, and propose measures to improve hospital registration performance, track trends, and assist with preventive actions. They will leverage patient access and revenue cycle knowledge for continuous quality improvement, conduct facility analysis of denials, and prepare review findings with recommendations. Collaboration with interdepartmental leaders, clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance, and other revenue cycle departments is crucial for strategic denial initiatives and revenue enhancement. The role also requires staying updated on regulatory and payer changes to ensure correct charging and billing requirements are met.

Requirements

• High school diploma.
• Three (3) years of revenue cycle experience.
• Billing, Coding, PA, Revenue Integrity, collections, etc.
• Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, managed care contracts and coordination of benefits)

Nice To Haves

• Certification and membership in AAPC, AHIMA, HFMA, AAHAM, NAHAM strongly preferred
• 3 years revenue cycle, non-acute care.
• Bachelor’s degree in related field, preferred
• Understands Revenue Cycle Key Performance Indicators and can identify vulnerabilities related to quality performance.
• Working knowledge of denials related software technology strongly preferred.
• Knowledge and experience of Revenue Cycle.

Responsibilities

• Researches, collects & analyzes information.
• Identifies opportunities, develops solutions, & leads through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
• Responsible for distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports & develop educational materials.
• Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
• Research & compiles information to support ad-hoc operational projects & initiatives.
• Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.
• Maintains a working knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects safe, honest, ethical & professional behavior & safe work practices.
• Develops, monitors, inspects & proposes measures to correct and improve hospital registration performance.
• Tracks and reports trends to remediate issues and assist with preventive actions for ongoing internal process improvement.
• Leverages patient access and revenue cycle knowledge to ensure continuous quality improvement.
• Conducts facility analysis of denials.
• Prepares and submits review findings, makes recommendations, and works closely with interdepartmental leaders to implement solutions.
• Proactively facilitates cross-departmental collaboration with clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance and other revenue cycle departments to continuously drive strategic denial initiatives and resolution around identified revenue enhancement opportunities.
• Maintains an understanding of regulatory and payer changes.
• Maintains an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.

Benefits

• Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees