Sr. Clinical Revenue Specialist

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 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. 

• 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 equi