Revenue Integrity Specialist

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. In particular, this position is responsible for collaborating with department revenue leads and frontline staff 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 Integrity Director. 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 Revenue Liaison serves as a resource and advisor to Trinity (i.e., Unified Revenue Organization, Physician Network Operations, Trinity Information Services), keeping the project team apprised of Maryland-specific compliance regulations that may impact the hospital’s ability to leverage system functionality. The Revenue Integrity Specialist also provides support, when requested, to other revenue cycle system implementation projects. Throughout project planning and implementation, the Revenue Integrity Specialist is responsible for the creation of implementation strategies and data production, working with vendors and 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 Revenue Integrity Specialist coordinates between the Reimbursement, Patient Accounting, and Patient Access to guide clinical departments in selecting and implementing appropriate and effective charge processes. Following a change or new process implementation, the Revenue Integrity Specialist provides ongoing data support, communicating feedback to the clinical department, ensuring all system pieces are in place and functioning correctly. The Revenue Integrity Specialist is also responsible for compiling and monitoring revenue cycle performance indicators against budgeted targets and Trinity or industry benchmarks available. The Revenue Integrity Specialist 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 Trinity Health and Holy Cross Hospital.

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.  In particular, this position is responsible for collaborating with department revenue leads and frontline staff 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.  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 Revenue Liaison serves as a resource and advisor to Trinity (i.e., Unified Revenue Organization, Physician Network Operations, Trinity Information 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 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 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, 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 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 Trinity Health and Holy Cross Hospital. 

Minimum licensure/certification required (if applicable):

None.

Minimum Knowledge, Skills, & Abilities Required:

  • Bachelor's degree in Statistics, Information Systems, Economics or related discipline
  • Master's degree in Statistics, Information Systems, Economics (strongly preferred). Equivalent combination of education and experience may be considered.
  • A minimum of 2-4 years of experience working in data in Statistics, Information Systems, Economics fields
  • A minimum of 2-4 years of progressive experience in revenue cycle operations and related healthcare regulatory requirements.  Project management and system conversion experience 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 McKesson and Cerner products preferred.

Reporting Relationship:

Reports to the Director of Revenue Informatics

Working Conditions:

  • General office environment with constant interaction with Finance staff and external contacts.
  • Volume of telephone calls and variation of workload can cause uneven workflow and stress.
  • 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.