What are the responsibilities and job description for the Revenue Specialist position at Trinity Health - IHA?
POSITION DESCRIPTION:
The Revenue Specialist improves compliant and accurate billing and charge capture at the point of service to decrease costly back-end work and improve cash flow. Implements and promotes consistent revenue integrity practices in regard to compliance in coding, billing and proper documentation. Optimizes reimbursement, working in partnership with departments to further develop the revenue stream and documentation processes. Analyzes and assists with correction of billing and coding errors identified by working denials. Monitors detailed revenue volumes via claim edits, and late charges and bad debt adjustments to provide real time notification to unusual variances. Works with the Site Operations team to provide feedback regarding proper revenue cycle processes and workflows. Assists or advises departments regarding resolution of errors that prevent timely, accurate and compliant claims submittal. Manages regulatory content, simplifying the complex reimbursement environment through promotion and support of consistent operational efficiencies. Helps departments to maximize revenue when CPT (Current Procedural Technology) codes for new technologies and services, or change in the payment rates for these and other established services occur.
ESSENTIAL JOB FUNCTIONS:
- Reviews weekly reports to analyze data, prioritize opportunities and assists in documenting plans of how to improve revenue cycle metrics when the offices or billing are not meeting expected benchmarks. Considers people, process and tools required to develop appropriate plan(s).
- Uses internal and external resources to create timely and thorough action plans related to a focused area of revenue cycle (i.e., charge entry or copays).
- Provides input for playbooks which are required to implement a regional revenue structure.
- Collaborates with assigned site location(s)’ front office and billing colleagues to improve revenue cycle performance by reviewing weekly metrics, assessing root cause analysis, and developing/implementing action plans.
- Responsible for helping communicate denials and provide feedback regarding how to reduce denials and improve processes.
- Responsible to grant end-user access to payer websites.
- Serves as a subject matter expert in assigned areas of revenue.
- Facilitates education/training to assigned sites or colleagues as needed.
- Meets with Revenue Optimization Team to ensure all assigned sites and colleagues are supported for all areas of revenue cycle.
- Assumes ownership of assigned tasks, prioritizes work with/without leader input and moves projects to completion (in a timely manner).
- Participates in revenue targeted projects and addresses opportunities and barriers as they arise.
- Provides regular project updates to customers and leadership especially when there are delays or challenges.
- Attends additional training, performs research, e-learning to stay current on best practices and new practice management technology and functionality as it becomes available.
- Documents lessons learned to develop payer, coding and/or billing playbooks for all specialties. Assists in the creation of monthly newsletters that will be distributed to front office and billing colleagues.
- Assists with special projects as needed.
- Performs other duties as assigned.
ORGANIZATIONAL EXPECTATIONS:
- Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
- Must be able to work effectively as a member of the Revenue Site Operations team.
- Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
- Maintains knowledge of and complies with IHA standards, policies and procedures.
- Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
- Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
- Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
- Uses resources efficiently.
- If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.
MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: High School Diploma.
CREDENTIALS/LICENSURE: NA
MINIMUM EXPERIENCE: 3-5 years’ recent coding or billing experience in a medical records department. Experience/knowledge of electronic practice management systems preferred (e.g., EPIC, NextGen and/or Athena).
POSITION REQUIREMENTS (ABILITIES & SKILLS):
- Strong attention to detail and organizational skills.
- Ability to work independently and with limited supervision. Ability to work in a team environment providing support to multiple positions.
- Ability to resolve problems and complete assignments accurately and timely.
- Ability to provide input regarding training manuals and written processes.
- Must be able to adapt to changing work priorities.
- Requires knowledge of physician group practice revenue cycle coding, charge entry, and claim submission.
- Ability to develop workable implementation plans; communicate changes effectively; build commitment and overcome resistance. Ability to prepare and support those affected by change and monitor transition and evaluate results.
- Excellent communication skills in both written and verbal forms, including proper phone etiquette and interpersonal skills. Ability to speak before groups of people, either in-person or virtually.
- Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
- Ability to work collaboratively in a team-oriented environment; displays courteous, professional and friendly demeanor.
- Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, family members, insurance carriers, and vendors.
- Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
- Ability to exercise sound critical thinking, problem-solving and decision-making skills combined with analytical expertise.
- Ability to handle patient and organizational information in a confidential manner.
- Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
- Ability to travel to other office/practice sites and meeting and training locations.
- Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
- Physical activity that often requires keyboarding, phone work and charting.
- Physical activity that often requires extensive time working on a computer.
- Physical activity that often requires handling and lifting patients walking, standing, bending, stooping, reaching, climbing, kneeling and/or twisting.
- Physical activity that often requires lifting, pushing and/or pulling up to 20 lbs.
- Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
- Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates in a typical office environment which involves frequent interruptions. This position requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.
Location: Central · Revenue Site Operations
Schedule: Full Time, 40
