Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization. Investigates denials and root causes, which includes performing thorough chart reviews, providing education to clinical colleagues, and tracking of identified trends. Leverages clinical knowledge and standard procedures to ensure timely attention to denials as requested by PBS and applicable appeal data gathering. Responsible for retrospective charge reviews, and Outpatient CDI reviews and assistance with third party charge audits. May require travelling between locations within the region.
MINIMUM QUALIFICATIONSLicensure/Certification:
Registered Nurse or Licensed Vocational Nurse/ Licensed Practical Nurse and graduate of an accredited school of nursing, plus at least four (4) years of nursing experience and two (2) years of charge audit, managed care or comparable patient payment processing experience preferred.
Must have current registration with the State Board of Nursing Examiners or have a temporary permit to practice nursing in the assigned state.
Bachelor's Degree preferred.
Must possess a demonstrated knowledge of revenue cycle and denial management functions. AAPC, AHIMA, CHRI certification/membership strongly preferred.
Knowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care.
Knowledge of and experience in case management and utilization management.
Outpatient CDI experience preferred.
Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required. Working knowledge of medical terminology, and medical record coding experience (ICD-9, CPT, HCPCS) are highly desirable.
Customer service background is required. Working knowledge of Electronic Health Records (EHR) is preferred.
Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally.
Must possess in-depth familiarity with third party billing requirements and regulations.
Excellent verbal and written communication and organizational abilities. Accuracy, attentiveness to detail and time management skills are required.
Must be comfortable operating in a collaborative, shared leadership environment.
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.
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.