Senior Revenue Cycle 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 capture 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. These revenue validation tools ensure timely billing and accurate reimbursement.
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 equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS...
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion wi