Sr. Clinical Revenue Specialist

2 weeks ago

Cincinnati, United States TriHealth Full time

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 documentationOther Licensed Clinical Professional Upon Hire Required Other Coding Credentials Upon Hire PreferredJob 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

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