Trinity Health logo
Trinity Health

We are one of the largest not-for-profit, faith-based health care systems in the nation.

Supervisor Revenue Integrity & Optimization

Location

United States

Posted

29 days ago

Salary

$31 - $47 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Supervisor Revenue Integrity & Optimization

Trinity Health

Role Description 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 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. - 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. - Works with other Revenue Integrity leaders to formally assess the developmental needs of the department on a periodic basis. - 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. - Analyzes and displays data in meaningful formats; develops and communicates policies/procedures and other business documentation. - Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct. - Other duties as assigned. Qualifications - Must possess a comprehensive knowledge of Hospital and Physician Practice operations. - 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. - 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. - Strong understanding of appeals, denial management, medical necessity, and coding audits. - Licensure / Certification: RHIA, RHIT, CCS, CPC/COC, or other coding credentials strongly preferred. - Experience in Charge Description Master (CDM) maintenance is strongly preferred. - 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. - 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. - 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. Requirements - This position operates in a typical office environment. - Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. - Manual dexterity is needed to operate a keyboard. - Hearing is needed for extensive telephone and in person communication. - Must be able to set and organize own work priorities and adapt to them as they change frequently. Benefits - Hourly pay range: $31.2563 - $46.8845. 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.

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