Revenue Integrity Recovery Coordinator

Position Purpose

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.

Responsibilities

• 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.
• Works complex denial coordination with intra-team members to identify root cause.
• Performs audits and collaborates with intra and inter-departmental teams on compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis.
• Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided.
• Completes assigned reports timely and accurately.
• May be required to travel between locations within the Region.

Requirements

• Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing.
• Must have five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.
• Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of 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 is required.
• Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification), CHRI preferred.

Qualifications

• Must possess a 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.
• Knowledge of 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).

Skills

• 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 is required.
• Excellent interpersonal, verbal, and written communication and organizational abilities.
• Accuracy, strong analytical skills, attentiveness to detail and time management skills are required.
• Comfortable operating in a collaborative, shared leadership environment.
• Personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.

Position Highlights

• Our mission and core values are what drive each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.
• Referral Rewards Program

St. Mary Medical Center

• A beautiful 53-acre state-of-the-art facility comprised of more than 700 physicians, nearly 3,000 colleagues, and 1,100 volunteers committed to providing quality care delivered with compassion and respect.
• 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.
• 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.