Trinity Health ยท 1 day ago
Supervisor, Revenue Integrity & Optimization (Remote)
Livonia, MI
Full-time
Remote
Mid Level
$31.26/hr - $46.88/hr
3+ years exp
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Responsibilities
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.
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.
Maintains a working knowledge of applicable Federal, State and local lawas 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.
Qualification
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Required
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.
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.
Preferred
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.
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.
Company
Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation.
10001+ employees
H1B Sponsorship
Trinity Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (6)
2022 (11)
2021 (7)
2020 (10)
Funding
Current Stage
Late StageLeadership Team
Dan Drake
Trinity Health PACE President and CEO
Eileen Coogan
Pres/CEO Allegany Franciscan Ministries
Recent News
FierceHealthcare
2024-03-01
2024-02-28
Hartford Business Journal
2024-01-08
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