Revenue Account Specialist- Regional- St. Joseph Mercy
Company: Trinity Health
Posted on: March 15, 2020
An Opportunity to Join our Remarkable Care Revenue Integrity
Account Specialistawaits YOU!!!!This is a regional position.**St.
Joseph Mercy Health System (SJMHS) is one of the nation's top
healthcare service providers, spanning five counties in
Southeastern Michigan. SJMHS represents more than 2,700 physicians
and 14,000 nurses and staff, and includes 5 Hospitals, 5 Outpatient
Health Centers, 8 Urgent Care Facilities and over 25 Specialty
Centers. Saint Joseph Mercy Health System is part of Trinity
Health, one of the largest multi-institutional Catholic health care
delivery systems in the nation, serving communities in 21 states
with 86 hospitals, 128 continuing care facilities and home health
and hospice programs.POSITION PURPOSEPerforms analysis of patient
clinical and billing data to identify documentation, coding and
charging opportunities. Works pre-bill edits and collaborates with
intra-departmental team members to identify root cause. Assists
with 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.ESSENTIAL
- Knows, understands, incorporates, and demonstrates the Trinity
Health Mission, Vision, and Values in behaviors, practices, and
- Responsible for working the pre-bill edits within bill drop
window, including but not limited to OCE/CCI, claim scrubber edits,
and DNFB. Collaborates with intra-departmental team to determine
root cause. Meets expected performance metrics and goals.
- Assists inter and intra-departmental teams on denial
investigations and root cause analysis. Including identifying
opportunities for denial prevention through the revenue cycle.
- Performs other revenue optimization activities as appropriate
and may assist centralized charge control team when necessary.
- Maintains an understanding of regulatory and payer changes to
ensure correct charging and billing requirements are met.
- Communicates and follows-up with designated Utilization Review
staff regarding clinical denials. Works with Patient Business
Service (PBS) center on requests to or from PBS as needed for payer
requests and/or claim adjudication.
- 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
- Other duties as assigned.
- Maintains a working knowledge of applicable Federal, State and
local laws/regulations; the Trinity Health Integrity and Compliance
Program and Code of Conduct as well as other policies and
procedures in order to ensure adherence in a manner that reflects
honest, ethical and professional behavior.MINIMUM QUALIFICATIONS
- Must possess a demonstrated knowledge of clinical processes,
charge master maintenance, clinical coding (CPT, ICD-10, revenue
codes and modifiers), charging processes and audits, and clinical
billing as normally obtained through a Bachelor's degree in
Healthcare or Business Administration, Finance, Accounting,
Nursing, or a related field, or an equivalent combination of years
of education and experience.
- Three (3) or more years of experience in billing, charge
documentation, charge audit or charge capture activities, or other
functions related to revenue cycle activities.
- Proficiency with MS Excel, Access, Business Objects highly
desired, and strong level of competency with Word and
- Working knowledge of third party payer rules and requirements,
computer operations and electronic interfaces related to charge
documentation, capture and billing is required. Licensure /
Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials
strongly preferred. CDC (Healthcare Compliance Certification)
- Must possess a demonstrated knowledge of clinical processes;
charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10,
revenue codes and modifiers), charging processes and audits, and
- Knowledge of Ambulatory Payment Classification (APC), and
Outpatient Prospective Payment System (OPPS) reimbursement
structures and prebill edits including Outpatient Coding Edits
(OCE)/Correct Coding Initiative (CCI) edits and Discharged Note
Final Billed (DNFB).
- Must be able to work in an environment that may be stressful
with a variety of individuals having diverse personalities and work
- Exceptional organizational skills and ability to prioritize and
manage multiple functions and responsibilities simultaneously.
- Possess strong analytical, interpersonal, written and verbal
- Knowledge of charge capture, reconciliation, error management
operations and overall revenue cycle operations required.**Why St.
Joseph Mercy Health System?*Competitive Salaries and Shift
Differentials*Rich Benefits package which include Medical, Dental,
Vision, Paid Time off, Retirement Saving Plan with employer
contribution option, Tuition Reimbursement, Life Insurance and
Short/Long Term Disability.
- Opportunity for growth and advancement throughout Trinity
Health in 21 different states!!Visit www.stjoeshealth.org/careers
to learn more about the benefits, culture and career development
opportunities available to you at Saint Joseph Mercy Health
System.ApplyJob Number: 00185645Location: Livonia, MIOrganization
Name: Saint Joseph Mercy Health SystemFacility: SJSEMI - St. Mary
Hosp LivoniaEmployment Type: Full timeHours: 40
Keywords: Trinity Health, Livonia , Revenue Account Specialist- Regional- St. Joseph Mercy, Other , Livonia, Michigan
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