Senior Professional Services Revenue Integrity Specialist

General Summary:

The Senior Revenue Specialist has responsibilities for 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.  Responsible for collaborating with department revenue leads and clinical providers to ensure accurate, sustainable and regulatory-compliant charge capture operations are in place for professional services revenue operations.  Advances the current charge capture systems and processes, in accordance with state and federal regulatory guidelines, billing documentation requirements, and leading hospital and physician practices, and making recommendations for enhancement to the Director. 

Independently coordinates the systems/process improvement related to charge capture, coding, billing, compliance, and revenue/documentation integrity activities for professional services providers. Responsibilities include detailed advanced-level analysis of data to ensure professional revenue key performance indicators are met, and best practice processes are implemented. Has cross-over responsibilities to hospital revenue oversight activities in some unregulated revenue areas. The Senior is responsible for developing revenue cycle performance indicators against budgeted targets and Trinity or industry benchmarks available.

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 4-6 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 4-6 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.
  • Advanced skills in organizing and presenting 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 EHR (Electronic Health Record), 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 Reimbursement and Revenue Integrity

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.