Remote Payer Strategy Jobs in Michigan (NOW HIRING)

Purpose

Work Remote Position

Frontline, department-based; Supervises daily functions of assigned department; Provides clear direction & manages / advances people, processes, structures & / or programs that support direct / indirect care. The leader demonstrates behaviors in alignment with culture & creates / supports comprehensive strategies & measures progress to achieve desired outcomes.

Note: "patients" refers to patients, clients, residents, participants, customers, members

Essential Functions

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus: Responsible for the daily operations & the oversight of staff. Supervisors work in collaboration with department managers to manage staff & department effectively. Participates in & contributes to the performance management / review process. Implements departmental plans & priorities identified by accountable leaders. May participate & recommend in the hiring & selection process. Responds promptly & directly to meet or exceed customers' needs.

Process Focus: Follows standards of performance & work processes in designated areas. Coordinates staff scheduling & assignment. Reviews & approves administrative functions (time, payroll, expense). Stewards productive use of resources (e.g., people, financial, equipment, supplies, materials) to achieve assigned commitments, experiences & quality standards.

Communication: Employs effective & respectful written, verbal & nonverbal communications; Develops an environment of mutual confidence & trust through collaborative relationships; Effectively communicates goals, standards, program expectations, service performance & how the work serves Trinity Health objectives; Proactively recognizes, addresses & / or escalates organizational, operational, or team conflicts.

Environment: Performs work in an environmentally safe, professional & healthy manner; self-monitors & initiates corrections and /or seeks guidance when needed. Demonstrates flexibility & self-direction by responding as a team player. Helps to create a positive work environment that promotes productivity. Accountable for continuous self-development & supporting the growth of others.

Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Functional Role (not inclusive of titles or advancement career progression)

Provides day-to-day operational supervision for local hospital & / or Medical Group Provider Services (THMG) revenue integrity functions.

Prevents revenue leakage & maximizes potential revenue for the region through supervision of Charge Description Master (CDM), revenue integrity pre-bill edits, and root cause analysis, , including audits & & educating & training of multi-disciplinary hospital and/or THMG teams.

Works with Revenue Integrity leadership & Payer Strategies to ensure understanding of payer contracts, application of contract terms & ensures alignment with charging processes.

Monitors all Medicare & Medicaid websites, other payer websites & newsletters regarding medical policies & changes impacting charging, compliance, coding & billing. Supervises the process to apply updates & ensures compliance & revenue optimization.

Elicits feedback from interdisciplinary teams, including clinical colleagues & involves them in decision-making as appropriate. Ensure problem resolution & corrective action for long-term solutions, coordinating such efforts across the inter & intra-departmental channels.

Analyzes & displays data in meaningful formats; develops & communicates policies/procedures & other business documentation; manages & conducts special studies & prepares management reports, including Key Performance Indicators as they relate to the department.

(Pay Range: $31.8795-$47.8193)

Minimum Qualifications

High school diploma or equivalent.

Three (3) to Five (5) years of progressively responsible experience in revenue cycle operations or an equivalent combination of education & progressive revenue cycle experience, or revenue cycle consulting experience.

Comprehensive knowledge of Hospital &/or Physician Practice operations required.

Strong knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC) & Outpatient Prospective Payment System (OPPS) reimbursement structures & prebill edits including Outpatient Coding Edits (OCE) / Correct Coding Initiative (CCI) edits & Discharged Note Final Billed (DNFB)

Additional Qualifications (nice to have)

Associate degree preferred.

Supervisor or team leader experience preferred.

Licensure / Certification: RHIA, RHIT, CCS, CPC / COC, or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) & CHRI (Certificate in Healthcare Revenue Integrity) preferred.

Strong understanding of nationally & locally recognized charging practices, medical necessity & coding audits with ability to read medical charts & dictations & correlate services to charges on the claims forms (UB & 1500 forms).

Experience in Charge Description Master (CDM) maintenance is strongly preferred.

Physical & Mental Requirements & Working Conditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:
Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
Exposure to fumes, odors, dusts,mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
Exposure to interruptions, shifting priorities & stressful situations. Frequent
Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous
Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Continuous
Perform manual dexterity activities & / or grasping / handling. Frequent
Ability to climb, kneel, crouch & / or operate foot controls. Occasional
Use of computer / other technology. Continuous
Sit with the ability to vary / adjust physical position or activity. Continuous
Maintain a safe working environment & use available personal protective equipment (PPE). Frequent
Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous
Ability to provide assistance in the event of an emergency. Occasional

Direct Healthcare Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
Lift a maximum of 30 pounds unassisted. Occasional
Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional

Indirect Healthcare / Support Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional

Lift a maximum of 30 pounds unassisted. Occasional
Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
Encounter a clinical / patient facing / hands on interactive work environment. Frequent
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
Work outdoors with variable external environmental conditions. Occasional

KEY: Average Workday Activity: Occasional (1% - 33%), Frequent (34% - 66%), Continuous (67% - 100%)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.