Trinity Health

Medical Billing and Coding

• Performs the day-to-day billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team assigned to a PBS location responsible for billing and follow-up of government and non-government accounts
• Provides training and guidance to lower level colleagues and provide problem resolution as needed
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information
• Performs all follow-up functions which includes the investigation of overpayments, underpayments, credit balances and payment delays
• Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required
• May prepare special reports as directed by the Supervisor Billing and Follow-Up to document follow-up services
• Assists in the training and education of Billing and Follow-up Representative I colleagues upon hire and ongoing

Billing and Follow-up Representative II – Hospital Medical Billing Follow-up – Commercial Payors

• Performs day-to-day billing and follow-up activities within revenue operations for assigned Patient Business Services (PBS) location
• Serves as a member of the billing and follow-up team responsible for billing and follow-up of accounts
• Provides training and guidance to lower level colleagues and problem resolution as needed
• Documents claims billed, paid, settled, and follow-up in appropriate system(s)
• Identifies and escalates issues affecting accurate billing and follow-up activities
• Adheres to proactive practices which includes contacting the payer directly for payment due on accounts
• Communicates with appropriate hospital departments to clarify billing discrepancies
• Performs follow-up functions including investigation of overpayments, underpayments, credit balances, and payment delays
• Researches claim rejections, makes corrections, and conducts corrective actions

Billing and Follow-Up Representative, Medical Billing Follow-up – Commercial Payors

Medical Director

• Provides service to the medical staff and hospital leadership
• Assists the medical staff in fulfilling their mission and objectives
• Plays a key role in the implementation of strategic and operating plans
• Promotes all programs and services to referring physicians
• Sets a universal standard for the delivery of patient care

Chief Medical Officer – CMO

Learning and Development

• Qualified and willing to float throughout the hospital and/or throughout multiple hospital locations and/or regions
• Knows, understands, incorporates & demonstrates standard elements of professional practice: Assess, Outcomes Identification / Solutions, Plan, Implement, Evaluate
• Acts independently & appropriately within license, scope of knowledge & experience in practice area
• Retains accountability for delegation, choices, decisions & outcomes
• Collaborates with key stakeholders & contributes to quality & improvement practices & outcomes
• Exhibits agility & willingness to take on new & additional responsibilities
• Embraces new ideas & cultural differences while managing competing priorities

Travel Registered Nurse, RN, L&D

Therapist

• Qualified and willing to float throughout the hospital and/or throughout multiple hospital locations and/or regions
• Knows, understands, incorporates & demonstrates standard elements of professional practice per AARC guidelines.
• Acts independently & appropriately within, scope of knowledge & experience in practice area
• Retains accountability for delegation, choices, decisions & outcomes
• Collaborates with key stakeholders & contributes to quality & improvement practices & outcomes
• Exhibits agility & willingness to take on new & additional responsibilities
• Embraces new ideas & cultural differences while managing competing priorities

Travel Respiratory Therapist, RT

Travel Registered Nurse, RN, L&D, Per Diem

• The Coding Specialist analyzes physician/provider documentation contained in health records to determine the principal diagnosis
• Utilizes encoder software applications, which includes all applicable online tools and references in assignment of diagnosis and procedure codes
• Determining principal procedure and secondary procedures

Coding Specialist

Vice President

• Responsible for payer contracting for the service area consisting of several Regional Health Ministries (RHM) across Illinois, Indiana, Iowa, Idaho, Oregon and California
• Manages negotiation cycle from assessment and identification of value creation opportunities through implementation of the contract
• Negotiates complex and innovative payer contracts
• Coaches team on advanced negotiation methods for APM contracting
• Strives to maintain competitive reimbursement rates for the RHMs within the region
• Oversees delivery of new contracts that leverage alternative reimbursement methodologies such as bundled payment and capitation
• Monitors regional trends by payer and maintains knowledge base by payer
• Provides management oversight of professional and managerial staff within Managed Care

Vice President, Managed Care Service Area 1

Manager

• Manage and oversee billing and follow-up activities for government and non-government accounts
• Motivate team to achieve customer satisfaction and operational goals
• Develop strategies to maximize reimbursement and ensure timely claims resolution
• Monitor operations and ensure continuous improvement of service delivery

Manager, Billing and Follow-up – Home Health Services

Recruitment

• Manage high-volume recruitment for physician/advanced practitioners
• Source candidates, maintain communication, and negotiate offers
• Process candidates through the hire stage
• Attend evening and weekend recruitment events, including career fairs

Physician Recruiter

Consultant

• Provides managerial direction and consultation for major payer contracting initiatives
• Leads negotiations and problem-issue resolution for major Managed Care payers
• Develops and implements managed care strategies in collaboration with Regional Health Ministries
• Manages executive relationships and engages stakeholders in meetings and initiatives
• Ensures compliance with legal, financial, and business requirements through project management

Senior Managed Care Contracting Consultant

Analyst

• Provides advanced technical and analytical support for Trinity Health's Payer Strategy & Product Development Department.
• Work assignments require in depth knowledge of financial and clinical analyses and cost and utilization trends related to payers, employers, and health plan data.
• Develops, implements and utilizes databases and reporting tools to extract data, generate reports, perform complex data analysis.
• Conducts impact analyses and modeling, assesses utilization trends, identifies risks, develops projections, prepares recommendations for management review.
• Uses data manipulation coding (i.e., SAS, SQL & R) to extract claims and membership data to support advanced healthcare analytics.
• Participates on teams that develop process improvement initiatives which enhance the performance of payer claims analysis.

Population Health Analyst II

Collections

• Responsible for implementing both strategic and tactical reimbursement activities
• Provides leadership, strategic direction and supervision of reimbursement functions
• Manages the implementation and evaluation of corporate reimbursement policies and procedures
• Interaction and collaboration with public and private payors, physicians, case managers, and various groups within the pharmacy
• Formulates reimbursement policy strategy and implements these strategies

Billing and Follow-up Representative II – Hospital Medical Billing Follow-up – Commercial Payors

Billing and Follow-Up Representative, Medical Billing Follow-up – Commercial Payors

Chief Medical Officer – CMO

Travel Registered Nurse, RN, L&D

Travel Registered Nurse, RN, L&D

Travel Respiratory Therapist, RT

Travel Registered Nurse, RN, L&D, Per Diem

Coding Specialist

Vice President, Managed Care Service Area 1

Travel Respiratory Therapist, RT

Manager, Billing and Follow-up – Home Health Services

Physician Recruiter

Senior Managed Care Contracting Consultant

Population Health Analyst II

Manager, Reimbursement & Collections – Specialty Pharmacy