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Revenue Integrity Recovery Coordinator - Primary Physician Network-CBO - Full-Time at Mercy Medical in South Bend, Indiana

Posted in Other 30+ days ago.

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Job Description:

14001_54620 SJPN Patient Financial Service
Expected Weekly Hours:
Day Shift

Position Purpose:
Responsible for performing in-depth analysis of patient clinical and billing data to identify documentation, coding and denial prevention. Develops and implements action plans for denial prevention based on root cause analysis findings. Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines. Responsible for working complex denial coordination with intra-team members to identify root cause. Performs audits and collaborates with intra and inter-departmental teams on 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. May be required to travel between locations within the Region.

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.

Job Description Details:

Minimum $26.52 Maximum $41.10

Actively demonstrates the organization's mission and core values and conducts oneself at all times in a manner consistent with these values. Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information. Collaborates with intra-departmental team on denial investigations and root cause analysis, which includes identifying opportunities for denial prevention along the revenue cycle. Performs analysis of data and reporting of trends, performance metrics, process improvements and impact to revenue. Performs other revenue optimization activities as appropriate, which includes providing education, process improvement, ongoing assessment and resolution of root cause issues. May assist centralized charge control team when necessary. Conducts departmental audits to ensure proper documentation and compliance with state and federal guidelines relating to the charge capture and billing of services. Prepares and submits audit findings, makes recommendations, and works closely with revenue integrity leadership and inter-departmental leaders to implement solutions. Collaborates with clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance and other revenue cycle departments on denial coordination, denial prevention and pre-bill edit prevention. Works closely with Revenue Liaison and/or Physician operational leaders, on system implementations, enhancements and new service line requests to ensure revenue cycle integrity and compliance. Works with ancillary teams and providers to develop processes to prevent future denials. Works in conjunction with leadership to track potential risk accounts and reviews with Finance to ensure there are no impacts to current reserves in the Bad Debt Charity Operational write-offs (BCO) model. Attends meetings with payer representative and/or vendors to address outstanding issues and/or stay informed of new regulations or guidelines. Attends monthly denial management meetings at individual ministries. Coordinates denials and appeals and/or reconsideration requests on clinical, coding and technical denials with PBS center, which may include outpatient RAC denials and appeals. Maintains denial and/or appeals logs and assessments in accordance with associated guidelines. Maintains an understanding of regulatory and payer changes to assure correct charging and billing requirements are met. 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. Performs other duties consistent with purpose of job as directed.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 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.

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