Department:OH1HS_69525_000 Revenue Optimization
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
Job Description Details:
Our Senior Revenue Integrity, Clinical Trials & Research Auditor position will focus on auditing of all clinical trial and research projects within Mount Carmel Health System. This includes review of trial budgets, clinical trial agreements and coverage analysis to insure that all aspects of clinical trial billing are aligned with Mount Carmel/ Trinity polices and CMS guidelines and regulations. This position will work directly with the Clinical Research Department In addition this positions will also conduct medical necessity audits do insure clinical documentation supports medical necessity, quality of care, utilization and coding of insurance claims to mitigate any associated risk with billing efforts.
- Develops processes to insure proper notification and billing for clinical trial/research claims Develops and implements policies and procedures as needed
- Works directly with the Clinical Research department to insure appropriate coverage and policies followed for all clinical trials. Reviews all clinical trial agreements and coverage analyses to insure compliance with Mount Carmel/Trinity policies and procedures and CMS regulatory guidelines Reviews budget agreements and determines appropriate payment rates to meet MCHS guidelines
- Reviews all research claims prior to submission for payment to payers and research sponsors to insure appropriate billing based upon each trial's clinical trial agreement, budget and coverage analysis
- Ensures the accuracy and integrity of medical documentation within the medical record and related coding.
- Conducts audits of charges and reviews medical record documentation. Identifies errors and issues with final coding related to existing charge capture, billing, documentation, and associated applications/systems
- Assists with resolving third-party payer inquiries and billing disputes, including Medicare, Medicaid and private insurance.
- Reviews medical records to determine whether documentation substantiates the medical necessity, quality of care, utilization, and coding of insurance claims to mitigate any associated risk with noncompliant billing and implement a proactive approach to the reduction of supplementary denials that may result.
- Conducts proactive audits for coding, quality assurance, medical necessity, and claim accuracy and analyzes for risk. Research, provide education and assist in the implementation of current and proposed documentation and chargy entry compliance and regulation
- Education: Bacheolors Degree in related field in lieu degree 10 years of progressive experience.
- License / Certification: Valid Ohio RN License preferred.
- Preferred three to five years of experience in related department, or operational revenue cycle team.
- Demonstrate positive and strong project managment abilities
- Current working knowledge of clinical trial/research billing practices and guidelines
- Demonstrated verbal and written communication skills including proper written grammar.
- Positive customer service oriented attitude and behavior
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.