Revenue Integrity Account Specialist - Acute Care

Employment Type:

Full time

Shift:

Day Shift

Description:

Trinity Health Mid-Atlantic is looking for an experienced Revenue Integrity Account Specialist to join our team!

Hybrid Schedule: Full-time, Monday-Friday (4 days remote, 1 day on-site)

Location: 41 University Drive Newtown, PA 18940

The Account Specialist will perform analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and collaborates with intra-departmental team members to identify root cause. Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately.

Responsibilities include, but not limited to:

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

• Responsible for working the pre-bill edits within bill drop window, including but not limited to OCE/CCI, claim scrubber edits, and DNFB. Collaborates with intra-departmental team to determine root cause. Meets expected performance metrics and goals.

• Assists inter and intra-departmental teams on denial investigations and root cause analysis. Including identifying opportunities for denial prevention through the revenue cycle.

• Performs other revenue optimization activities as appropriate and may assist centralized charge control team when necessary.

• Maintains an understanding of regulatory and payer changes to ensure correct charging and billing requirements are met.

• Works with Patient Business Service (PBS) center on requests to or from PBS as needed for payer requests and/or claim adjudication.

• Maintains working knowledge of coding and billing regulations for all payors. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance, and optimization.

• Other duties, as assigned.

Minimum Qualifications:

• Certification in Coding highly preferred (CPC or CCS)

• Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's or Associate's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.

• Three (3) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.

• Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.

• Working knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required.

• Must possess a demonstrated knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing.

We offer a competitive salary and comprehensive benefits including:

• Medical, Dental, & Vision Coverage (Effective First day of Hire)

• Retirement Savings Program

• Paid Time Off

• Tuition Reimbursement

• Free Parking

• And more!

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.