Senior Revenue Cycle Specialist

TriHealth • Cincinnati, OH

1d

About The Position

Job Overview: This position provides leadership to identify and implement hospital revenue enhancement opportunities. Consistent evaluation and understanding of changing third-party payer regulations is required to support accurate and compliant gross revenue capture for assigned service lines and hospital locations. The various hospital CDMs (charge description master) will be maintained with current and accurate revenue codes, CPT/HCPCS codes along with standardized descriptions and billing categories. The current gross revenue capture exceeds one billion dollars annually from the TriHealth hospital CDMs. This position requires working collaboratively across all of the revenue cycle, clinical areas, and purchasing to meet gross revenue targets. Coordination with various IT clinical analysts is required to implement charge capture tools that are accurately maintained and that are user friendly. Hospital services are analyzed annually for formulation of pricing strategies. Job Requirements: Bachelor's Degree (Required) 2 - 3 years experience licensed clinical professional (Required) Working knowledge and understanding of HCPCS CPT Revenue codes Budget development and RVUs Working knowledge and understanding of EPIC EMR navigation and clinical documentation Other Licensed Clinical Professional Upon Hire Required Other Coding Credentials Upon Hire Preferred Job Responsibilities: Provides leadership to identify and implement hospital revenue enhancement opportunities. Acts as a liaison, consultant and educator for hospital charge capture to leadership, clinical teams, charge entry team members, IT, billing, and purchasing. Maintains accurate and compliant CDM. Regularly reviews vendor CDM data scrubber's compliance reports for assigned service areas and hospital locations and takes necessary action to maximize compliant billing and reimbursement. Collaborates with leadership and clinical teams on annual strategic pricing to meet gross revenue targets. Actively develops with IS liaison, specific Revenue Integrity revenue guardian checks, claim edits, and work queue rules. These revenue validation tools ensure timely billing and accurate reimbursement. Facilitates development, implementation and provide monitoring of operational charge capture processes that meet regulatory compliance and that are effective for end-users. Working Conditions: Bending - Climbing - Rarely Concentrating - Continuous Learning - Hearing: Conversation - Consistently Hearing: Other Sounds - Frequently Interpersonal Communication - Kneeling - Rarely Lifting <10 Lbs. - Lifting 50+ Lbs. - Rarely Lifting <50 Lbs. - Occasionally Pulling - Rarely Pushing - Rarely Reaching - Rarely Reading - Consistently Sitting - Frequently Standing - Rarely Stooping - Rarely Talking - Consistently Thinking/Reasoning - Consistently Use of Hands - Frequently Color Vision - Occasionally Visual Acuity: Far - Frequently Visual Acuity: Near - Consistently Walking - Frequently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS... Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS... Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect: ALWAYS... Respect cultural and spiritual differences and honor individual preferences. Respect everyone's opinion and contribution, regardless of title/role. Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS... Value the time of others by striving to be on time, prepared and actively participating. Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS... Acknowledge wins and frequently thank team members and others for contributions. Show courtesy and compassion with customers, team members and the community

Requirements

• Bachelor's Degree (Required)
• 2 - 3 years experience licensed clinical professional (Required)
• Working knowledge and understanding of HCPCS CPT Revenue codes
• Budget development and RVUs
• Working knowledge and understanding of EPIC EMR navigation and clinical documentation
• Other Licensed Clinical Professional Upon Hire Required

Nice To Haves

• Other Coding Credentials Upon Hire Preferred

Responsibilities

• Provides leadership to identify and implement hospital revenue enhancement opportunities.
• Acts as a liaison, consultant and educator for hospital charge capture to leadership, clinical teams, charge entry team members, IT, billing, and purchasing.
• Maintains accurate and compliant CDM.
• Regularly reviews vendor CDM data scrubber's compliance reports for assigned service areas and hospital locations and takes necessary action to maximize compliant billing and reimbursement.
• Collaborates with leadership and clinical teams on annual strategic pricing to meet gross revenue targets.
• Actively develops with IS liaison, specific Revenue Integrity revenue guardian checks, claim edits, and work queue rules. These revenue validation tools ensure timely billing and accurate reimbursement.
• Facilitates development, implementation and provide monitoring of operational charge capture processes that meet regulatory compliance and that are effective for end-users.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees