[Hiring] Revenue Integrity Recovery Coordinator @Trinity Health

Role Description

Responsible for performing in-depth analysis of patient clinical and billing data to identify documentation, coding, and denial prevention. Develops and implements action plans for denial prevention based on root cause analysis findings. Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines.

• Collaborates with intra-departmental team on denial investigations and root cause analysis.
• Performs analysis of data and reporting of trends, performance metrics, process improvements and impact to revenue.
• Conducts departmental audits to ensure proper documentation and compliance with state and federal guidelines.
• Prepares and submits audit findings, makes recommendations, and works closely with revenue integrity leadership.
• Collaborates with clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance and other revenue cycle departments.
• Works closely with Revenue Liaison and/or Physician operational leaders on system implementations and enhancements.
• Attends meetings with payer representatives and/or vendors to address outstanding issues.
• Coordinates denials, audits and/or reconsideration requests on coding and technical denials.
• Maintains an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.
• Other duties, as assigned.

Qualifications

• Demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits.
• Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or equivalent combination of education and experience.
• Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities.
• Proficiency with MS Excel, Access, Business Objects, and strong competency with Word and PowerPoint.
• Working knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing.
• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred.
• Knowledge of Ambulatory Payment Classification (APC) and Outpatient Prospective Payment System (OPPS) reimbursement structures.
• Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
• Experience with post payment audits and with coding, clinical and technical denials.
• Excellent interpersonal, verbal, and written communication and organizational abilities.

Requirements

• Must be able to work in a stressful environment with diverse individuals.
• Accuracy, strong analytical skills, attentiveness to detail and time management skills are required.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must possess a personal presence characterized by honesty, integrity, and caring.

Benefits

• Compensation Range: $25.02 - $37.53

Company Description

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.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.