Revenue Integrity Account Specialist
Holy Cross

Job Info

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Employment Type:Full timeShift:Day Shift

Description:This is a remote, full-time position with 8-hour shifts during regular business hours (Monday-Friday). This position is responsible for all complex pre-bill edits including MUE, and CCI edits for all service lines including PBB edits. Position is responsible to complete work queues in alignment with CFB metrics, works closely with EPFS and ancillary depts.
What you will do:

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.

Communicates and follows-up with designated Utilization Review staff regarding clinical denials. 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.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code 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.

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.

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