GENERAL SUMMARY:
Reporting to the Manager, Revenue Integrity, the Revenue Integrity Senior Specialist has an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions, and interdependencies from the provision of patient care to final bill generation.
Under limited supervision from the Manager, Revenue Integrity or other more senior Revenue Integrity leaders, the Revenue Integrity (RI) Senior Specialist is responsible for the facilitation of multiple Revenue Integrity initiatives involving multiple clinical departments and practices focusing on revenue cycle integrity. The RI Senior Specialist understands hospital payor contracts and reimbursement methodologies. Works
collaboratively with Revenue Integrity staff to identify charge system weakness, recommend changes provide education, and track utilization.
Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills.
The RI Senior Specialist applies a variety of continuous improvement and process improvement initiatives working with individuals and teams from project conception to implementation of process improvement initiatives. Project work may include technical analyses or may require facilitation of a large multi-disciplinary group of administrators, providers, ancillary staff and other HFH team members. Works collaboratively with leadership to increase efficiencies, reduce variability, reduce errors/defects, provide training and education for all appropriate personnel. Prepares reports and
recommendations for management and coordinates implementation. Communicates regularly with Management on projects status.
This individual provides and collaborates with other departments on needed continuous improvement training and education, working closely with other RI personnel to meet education needs at all levels throughout the institution. Serves as a technical consultant to other HFH departments.
May supervise work of RI Specialists, RI Senior Auditors, RI Auditors, and other staff within the Revenue Integrity Department.
Flexibility, innovation, and creativity are necessary characteristics of the successful candidate. Individual is expected to continuously learn and apply new continuous improvement methodologies, and to spread successful innovation through the institution.
EDUCATION/EXPERIENCE REQUIRED:
* Bachelor's degree in Business Administration, Healthcare Administration, Nursing or related field, or five (5) years of leadership, consultative, and/or related experience in lieu of Bachelor's degree.
* Three (3) years experience in healthcare revenue cycle, finance, clinical areas, or related experience required.
* Hospital billing and healthcare finance background, preferred.
* Ability to work with and interpret detailed medical record documents and communicate effectively with physician, nursing staff, leadership and other HFH personnel.
* Knowledge of medical coding (facility and professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related to rules/coverage.
* Knowledge of Medicare, Medicaid, Blue Cross and other third-party payers billing and reimbursement regulations/policies, preferred.
* Excellent oral and written communication skills, including the ability to teach complex technical/analytical concepts to management and staff.
* EPIC experience, preferred.
* Ability to manage simultaneous assignments with potentially conflicting priorities and deadlines.
* Ability to identify when input from Director, Manager or other senior staff members is necessary.
* Strong interpersonal skills; ability to communicate effectively with all levels of management and staff across the System.
* Strong, growing base of analytical/technical, facilitative, and process improvement knowledge.
* Knowledge of effective data gathering techniques. Sound decision-making skills.
* Proven project management skills.
* Strong diplomacy and collaboration skills.
CERTIFICATIONS/LICENSURES REQUIRED:
* Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN,NP, PA) preferred.
* Certification in some or all of the following: Lean, Six Sigma or equivalent industry training and experience, preferred.
Additional Information
- Organization: Corporate Services
- Department: Revenue Integrity
- Shift: Day Job
- Union Code: Not Applicable
Henry Ford Health System
Dec 24, 2024