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Trinity Health Professional Services Revenue Integrity Specialist in Silver Spring, Maryland

General Summary:

The specific responsibility of this position is to serve as the revenue liaison between the revenue cycle management division, reimbursement department, the ancillary/clinical areas, and physician/provider areas that generate patient revenue from professional services at the hospital. In particular, this position is responsible for collaborating with department revenue leads and clinical providers to ensure accurate, sustainable and regulatory-compliant charge capture operations are in place to include daily charge entry, revenue reconciliation and error correction processes. This position is responsible for evaluating the current charge capture systems and processes in place against regulatory guidelines, billing documentation requirements, and leading hospital and physician practices, and making recommendations for enhancement to the Revenue Informatics Director.

The Professional Services-Revenue Liaison- serves as a link between the Reimbursement and Revenue Cycle divisions, professional billing company, all professional services clinical providers located at the hospital (i.e., PA, NP, Behavioral Health Specialists, Nutritionists, Physicians, etc.), health centers, and physician practice offices, and PNO contacts. This role is responsible for operationalizing systems/processes related to charge capture, coding, billing, compliance, and revenue/documentation integrity activities for professional services providers. Responsibilities include detailed analysis of data to ensure professional revenue key performance indicators are met, and best practice processes are implemented. Communication skills (both verbal and written) are essential, as this role will be responsible for communicating directly with providers about documentation improvement using statistical and evaluative reports, training materials, dashboards/scorecards, etc., and with vendors about coding/billing opportunities. This role does have cross-over responsibilities to hospital revenue oversight activities.

For those system enhancement or implementation projects approved related to charge capture, this position serves as the project coordinator, consistently communicating regulatory protocols and ensuring sufficient data guides all major implementation decisions. In the planning phase of revenue system changes, the Professional Services-Revenue Liaison serves as a resource and advisor to CHE Trinity (i.e., Revenue Excellence, Physician Network Operations, Information Technology Services), keeping the project team apprised of Maryland-specific compliance regulations that may impact the hospital’s ability to leverage system functionality.

The Liaison also provides support, when requested, to other revenue cycle system implementation projects. Throughout project planning and implementation, the Liaison is responsible for the creation of implementation strategies and data production, working with vendors and CHE Trinity Health representatives to ensure objectives are achieved, communicating progress and issues to management, and ensuring that each project achieves the improvements for which it was acquired. Similarly, as the hospital evolves to implement new or updated health care services, the Liaison coordinates between the Reimbursement, Patient Accounting, Patient Access, and Physician Practice Integration, Health Network departments to guide clinical departments in selecting and implementing appropriate and effective charge processes. Following a change or new process implementation, the Liaison provides ongoing data support, communicating feedback to the clinical department/providers, ensuring all system pieces are in place and functioning correctly.

The Liaison is also responsible for compiling and monitoring revenue cycle performance indicators against budgeted targets and CHE Trinity or industry benchmarks available. The Liaison serves as a resource for revenue cycle managers by assisting them with the analysis of current performance through data support and helping them interpret the data, when possible, in order to identify process improvements that support the provision of consistent, compliant, customer-driven and results-oriented revenue cycle services within the hospital.

Supports the Mission of CHE Trinity Health and Holy Cross Health.

Minimum licensure/certification required (if applicable):

Minimum Knowledge, Skills, & Abilities Required:

  • Bachelor’s degree from accredited college or university in Business or related discipline required. Master’s Degree preferred or equivalent combination of education and experience may be considered.
  • A minimum of 2-4 years of progressive experience in hospital and/or physician practice revenue cycle operations and related healthcare regulatory requirements is required. Project management and system conversion or implementation experience required.
  • A minimum of 2-4 years of experience managing professional services/physician practice billing, with a demonstrated record of success in achieving effective best practice results in charging, billing, and revenue compliance operations.
  • Experience in physician practice management system conversion strongly preferred.
  • The ability to organize and present information in a systematic format using spreadsheet and graphing capabilities. Skills in documenting performance flowcharts, summaries, and presentation formats.
  • Demonstrated leadership ability and a record of effective, team-oriented relationships with hospital staff, managers, senior management and medical staff, including medical staff leadership committees.
  • Strong analytical skills and ability to multi-task effectively.
  • Excellent communication skills in both written and verbal formats
  • Thorough knowledge of current trends and best practices in performance improvement and revenue cycle concepts, applications and methods.
  • Experience with the application of information systems as they apply to revenue cycle operations and health information systems. Knowledge of NextGen EPM and EHR, and Cerner PowerChart products is strongly preferred.
  • Demonstrated ability to solve complex problems involving multiple departments, simultaneous processes, and competing priorities using creative solutions.

Reporting Relationship:

Reports to the Director of Revenue Informatics

Working Conditions:

  • General office environment with constant interaction with revenue and clinical staff and external contacts.
  • Must be able to lift 20-35 pounds periodically.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer.

Qualified applicants are considered for employment without regard to Minority/Female/Disabled/Veteran (M/F/D/V) status.

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Job Number: 00108231

Location: Silver Spring, MD

Organization Name: Holy Cross Health

Facility: HCMD - Holy Cross Health Corporate

Employment Type: Full time

Shift: Day Shift

Hours: 40

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