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Description:

POSITION PURPOSE

Provides day-to-day operational supervision for local hospital and/or Medical Group Provider Services (MGPS) revenue integrity functions.  Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stakeholders and varying levels of leadership to prevent revenue leakage and maximize potential revenue for the region.  Supervises the Charge Description Master (CDM), revenue integrity pre-bill edits, root cause analysis, denials coordination with the Patient Business Service (PBS) center, including complex case denials, denial prevention, audits, and educating and training of multi-disciplinary hospital and/or MGPS teams.  Responsible for optimizing staff performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback.   

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices and decisions.

• Works with Revenue Integrity leadership and Payer Strategies to ensure understanding of payer contracts, application of contract terms and ensures alignment with processes.

• Monitors all Medicare and Medicaid websites, other payer websites and newsletters regarding medical policies and changes impacting charging, compliance, coding and billing.  Supervises the process to apply updates and ensure compliance and revenue optimization.

• Supervises the coordination of denials received from Patient Business Service (PBS) center, ensures staff timely resolution and identification of denials' root cause and initiates resolutions for denial prevention.  May assist PBS with complex denial appeals.  Works with PBS and other Revenue Integrity leaders to create and participate in ongoing multi-disciplinary denial team.

• Supervises and may perform root cause analysis on denials and pre-bill edits and collaborates with inter and intra-departmental teams to implement process and/or identify system intersection opportunities to address cause and optimize revenue. 

• Provides education to departments and colleagues on audit and root cause analysis findings, regulatory changes and requirements, coding updates and payer billing requirement changes.

• Develops colleague work schedules to ensure cost effective staffing that meets customer requirements and quality performance.  Supervises team projects, fosters interdisciplinary and intra-department collaborative relationships and promotes active participation.

• Elicits feedback from interdisciplinary team, including clinical colleagues, and involves them in decision-making as appropriate.  Ensure problem resolution and corrective action for long-term solution, coordinating such effort across the inter and intra-departmental channels.

• Works with other Revenue Integrity leaders to formally assesses the developmental needs of the department on a periodic basis and promotes opportunities for development in independent decision-making, effective communications and interpersonal relations to ensure customer satisfaction in conjunction with Trinity Health's core values and to foster team spirit.

• Works with other Revenue Integrity leaders to identify and implement opportunities for colleagues to increase knowledge base, advance practice and enhance professionalism through colleague orientation and continuing education opportunities. May manage some degree of colleague training to meet goals.

• May be responsible for hiring employees and recommending allocation of resources. Monitors and conducts performance appraisals, including review and approval of performance goals, performance and disciplinary actions.

• Provides feedback in a prompt, direct and positive manner; mentors and coaches colleagues to ensure positive outcomes. Provides counseling and/or conflict resolution regarding unresolved performance issues, demonstrating effective use of the disciplinary process.

• Analyzes and displays data in meaningful formats; develops and communicates policies/procedures and other business documentation; manages and conducts special studies and prepares management reports, including Key Performance Indicators as they relate to the department.

• Other duties as assigned.

• Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Hourly pay range: $31.26 - $46.88

MINIMUM QUALIFICATIONS

• Must possess a comprehensive knowledge of Hospital and Physician Practice operations, and a minimum of three (3) years of progressively responsible experience in revenue cycle operations or an equivalent combination of education and progressive revenue cycle experience or revenue cycle consulting experience. Associate's degree preferred.

• Supervisor or team leader experience preferred.

• Knowledge and experience in Revenue integrity in an acute care and/or Physician practice setting.

• Strong understanding of appeals, denial management, medical necessity, and coding audits with ability to read medical charts and dictations and correlate services to charges on the claims forms (UB and 1500 forms).

• Licensure / Certification:  RHIA, RHIT, CCS, CPC/COC, or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.

• Experience in Charge Description Master (CDM) maintenance is strongly preferred.

• Ability to organize, plan, and manage staff in Revenue Integrity and Optimization activities of a large healthcare acute and professional billing organization.

• Strong knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

• Knowledge of laws and payer contracts governing billing of hospital and/or physician services.

• Demonstrated ability to work effectively with a diverse group of people including physicians, clinicians, office managers, administrators, third party payers, governmental agencies and colleagues.

• Ability to understand and interpret complex issues and clinical processes and recommend improvements.

• Experience with data collection, analysis, and providing written reports, proposals incorporating findings.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• This position operates in a typical office environment.  The area is well lit, temperature controlled and free from hazards. 

• Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. 

• Manual dexterity is needed to operate a keyboard.  Hearing is needed for extensive telephone and in person communication. 

• The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions. 

• Must be able to set and organize own work priorities and adapt to them as they change frequently.  Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. 

• Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful.  May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.