Revenue and CDM Optimization Liaison

Role Description

Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications.

• Guides, communicates & educates on correct charge capture, billing & coding processes & local, state & federal guidelines.
• Examines, reports & makes recommendations regarding departmental charge activities for compliance with management plans & policies.
• Conducts special reviews for management to discover mechanics of detected fraud & to develop controls for fraud prevention.
• Reviews bulletins to maintain an understanding of regulatory & payer changes to assure correct charging & billing.
• Coordinates pricing increases as directed by Finance & utilizes strategic pricing applications to maximize payments within the hospital budget requirements.

Qualifications

• Bachelor's degree in healthcare or business administration, Finance, Accounting, Nursing or a related field, or an equivalent combination of years of education & experience.
• 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.
• Demonstrated knowledge of charge master maintenance, clinical processes, clinical coding (CPT, ICD-10, revenue codes & modifiers), charging processes & audits & clinical billing.
• Working knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to charge documentation, capture & billing.
• Knowledge of Ambulatory Payment Classification (APC) & Outpatient Prospective Payment System (OPPS) reimbursement structures & prebill edits including Outpatient Coding Edits (OCE) / Correct Coding Initiative (CCI) edits & Discharged Note Final Billed (DNFB).

Requirements

• Experience with CDM oversight strongly preferred.
• Licensure / Certification: RHIA, RHIT, CCS, CPC / COC or other coding credentials strongly preferred.
• CDC (Healthcare Compliance Certification) and CHRI (Certificate in Healthcare Revenue Integrity) are strongly preferred.

Benefits

• Compensation Range: $31.88 - $47.81 (Exempt)

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.