Revenue Protection Specialist
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Job Description
Revenue Protection Specialist analyzing hospital registration performance and denials for Trinity Health, a large nonprofit health care system. Driving revenue-cycle improvements, reporting trends, and implementing denial-resolution solutions.
Responsibilities:
- Research, collect, and analyze information
- Identify opportunities, develop solutions, and lead issues through resolution
- Collaborate on performance improvement activities related to program efficiency and patient experience
- Distribute analytical reports
- Use multiple system applications to perform analysis, create reports, and develop educational materials
- Research and compile information for ad-hoc operational projects and initiatives
- Synthesize and analyze data; prepare detailed summaries and graphical presentations showing trends
- Recommend practical options or solutions to support business strategy and leadership decision-making
- Define and demonstrate progress, ROI, and impacts using program and operational data
- Develop, monitor, inspect, and propose corrective measures to improve hospital registration performance
- Track and report trends to remediate issues and support preventive actions for internal process improvement
- Conduct facility analysis of denials
- Prepare and submit review findings and recommendations
- Work with interdepartmental leaders to implement solutions
- Facilitate cross-departmental collaboration with clinical departments, Patient Business Service center, Payer Strategies, Compliance, and revenue cycle departments
- Drive strategic denial initiatives and resolution of revenue enhancement opportunities
- Monitor regulatory and payer changes to support correct charging and billing requirements
Requirements:
- High school diploma
- Three (3) years of revenue cycle experience, including billing, coding, prior authorization, revenue integrity, or collections
- Knowledge of insurance and governmental programs, regulations, and billing processes, including Medicare, Medicaid, managed care contracts, and coordination of benefits
- Certification and membership in AAPC, AHIMA, HFMA, AAHAM, or NAHAM strongly preferred
- Bachelor’s degree in a related field preferred
- Understanding of Revenue Cycle Key Performance Indicators and ability to identify vulnerabilities related to quality performance
- Working knowledge of denials-related software technology strongly preferred
- Knowledge and experience of revenue cycle
- For Physician Billing Denials Prevention, three years of revenue cycle experience in non-acute care is an additional nice-to-have qualification
- Working knowledge of applicable federal, state, and local laws and regulations
- Knowledge of Trinity Health policies, procedures, guidelines, Integrity and Compliance Program, and Code of Conduct
Benefits:
- Equal Opportunity Employer
- Mission-driven, faith-based health care system
- Community benefit investment and person-centered care environment
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