Trinity Health Jobs

Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

Manages revenue integrity operations for the hospital(s) and/or Medical Group Provider Services (MGPS) in the region. Provides oversight and leadership for a team responsible for, but not limited to, charge description master (CDM) maintenance, centralized charge control, pre-bill edits, appropriate revenue and reimbursement, complex claim denial coordination, payer audits and denial prevention. Manages and monitors the audit results, data analysis and root cause issues and assists ministry departments with corrective action plans. Responsible for building collaborative relationships with RHM leadership, PBS and other key stakeholders. Motivates and challenges staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to prevent revenue deficits and maximize potential revenue for the region. Responsible for managing the optimization of staff performance through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and outcome feedback.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions

Manages and oversees people, systems and processes for revenue integrity, charge control functions, and the performance of standard regional revenue integrity metrics and quality.

Coordinates, synchronizes and monitors the work efforts of geographically dispersed Revenue Integrity and Charge Control work teams in order to ensure adherence to the established Standards of Excellence and ongoing monitoring of metrics and reporting of performance to senior leadership.

Facilitates and serves as a champion for process change. Works closely with Hospital Site Operations and/or MGPS leadership on implementing revenue enhancement initiatives and education.

Manages system enhancements, new programs and facility changes including analysis of impact on revenue, reimbursement and processes.

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, which includes Key Performance Indicators. Communicates finds to various levels of Leadership and multi-disciplinary teams.

Keeps abreast of all current payer medical policies, makes any changes to prevent loss in reimbursement, including but not limited to, Medicare and Medicaid web sites, Payer websites and newsletters for changes impacting charging, coding and billing. Develops and provides informational education/training to team members.

Responsible for ensuring all bill-above reimbursements are identified in the contracts, implemented at time of billing, properly submitted and correct reimbursements are received. Oversees complex case denial coordination with the Patient Business Service (PBS) centers, ensuring all actions are taken timely.

Works in conjunction with the Patient Business Service Center to create and lead local denial management team involving all revenue cycle and ancillary departments. Meets regularly to reduce and eliminate denials; provides problem resolution and improvements to denial management vendor processes and relations.

Performs root cause analysis on denials to gather a better understanding of issues. Prepares and conducts education and training services to departments and staff pursuant to audit and root cause findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes.

Manages team projects through empowerment and collaboration with team members. Fosters interdisciplinary collaborative relationships with Payer Strategies, PBS, Clinical Service lines, Physicians and other key stakeholders. Elicits feedback from interdisciplinary team and promotes collaborative decision making as appropriate. Acts as point of contact for Revenue Integrity team obtaining and exchanging information as needed.

Provides operational guidance and direction to assigned staff to ensure service integration, effective coordination of departmental work activities, and quality job performance.

Ensures problem resolution and corrective action for long-term solutions and coordinates such effort across intra and inter-departmental channels.

Responsible for periodically assessing developmental needs of the region and promoting opportunities for skill, independent decision making, effective communication and interpersonal relations development in order to achieve and maintain top decile levels of customer satisfaction while in consideration of Trinity Health’s core values and fostering team spirit.

Collaborates with Hospital Site Operations leader(s) to identify and implement opportunities for colleagues to increase their knowledge base, advance their practice and enhance their professionalism through colleague orientation and continuing education opportunities.

Manages recruitment, some degree of training, performance, discipline and termination of positions as necessary. Works with local managers determining and managing the appropriate allocation of resources across with region. Monitors and conducts performance appraisals and will work with Hospital Site Operations leader(s) in establishing cascading goals. Manages regular ongoing performance feedback in a prompt, direct and positive manner. Mentor and coaches colleagues.

Maintains a working knowledge of applicable Federal, State, and local laws 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.

Other duties as assigned

QUALIFICATIONS

Must possess a comprehensive knowledge of Hospital and/or provider operations, as normally acquired through the completion of Bachelor’s degree in Finance or Business Administration or related field and a minimum of five (5) to seven (7) years of progressively responsible experience healthcare revenue cycle operations including revenue integrity and charge control, preferably in a multi-site hospital setting, or an equivalent combination of education and experience.

Minimum of three (3) years of management experience in a multi-facility, integrated health care delivery system or revenue cycle or revenue integrity consulting experience.

Licensure / Certification: RHIA, RHIT, CCS, CPC/COC, CPC-H, or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred. Extensive understanding of correct coding principles of CPT/HCSPCS and modifier selection as well as CCI edits and billing guidelines.

Experience in working with multi-disciplinary teams and varying levels of leadership.

Strong analytical skills and demonstrated comprehension of complex clinical and revenue integrated systems and processes.

Strong experience in acute care and/or professional fee billing, charge capture, coding, error and denial management, process improvement and other key functions related to revenue integrity.

Strong understanding of contract management and how it may be applied across the region, appeals, denial prevention, medical necessity, and coding audits.

Previous Charge Description oversight required; practical experience strongly preferred.

Knowledge of laws governing billing of hospital and/or provider services and experience in implementing new processes and procedures to ensure compliance.

Demonstrated ability to effectively work with a diverse group of people that includes 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.

Ability to read medical charts and dictation, understand services performed, and correlate those services to charges on the bill (UB-04) and 1500 form.

Experienced with data collection, analysis, and providing written reports, proposals incorporating findings.

Must be comfortable operating in a collaborative, shared leadership environment.

Must be able to travel up to 50% to the various Trinity Health sites within the Region. May travel to RHMs outside of Region and System Office as may be necessary, typically under 10% of time.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

LEADERSHIP COMPETENCIES

As a Trinity Health Executive, the incumbent is expected to demonstrate leadership traits, which support our Mission Statement and Core Values as identified below:

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.

• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.

• Justice: We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.

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.

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.

Must possess the ability to comply with Trinity Health policies and procedures.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran