Senior Clinical Revenue Specialist

Join Tri Health as a Sr. Clinical Revenue Specialist! At Tri Health, you'll play a critical role behind the scenes, ensuring accurate revenue capture and supporting the financial strength that allows us to deliver exceptional care to the communities we serve. Join a collaborative, mission-driven team where your clinical expertise, analytical skills, and innovative thinking directly impact both patient care and organizational success.

As a trusted leader in healthcare, Tri Health offers a supportive culture, opportunities for professional growth, and the chance to work alongside clinical, operational, and technology teams to drive meaningful improvements. Here, your work will help shape revenue integrity strategies that support over $1 billion in annual hospital revenue while advancing our commitment to improving health and enhancing lives.

• Work from Home
• Must reside in Cincinnati-Dayton, Ohio, Northern Kentucky or Eastern Indiana to be considered.

• Full-Time (80 hours bi-weekly)
• Day Shift
• No Weekend, Holiday or On Call Commitment

Tri Health offers a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page

• Bachelor's Degree (Required)
• 2 - 3 years experience licensed clinical professional (Required)
• Working knowledge and understanding of HCPCS
• CPT
• Revenue codes
• Budget development and RVUs
• Working knowledge and understanding of EPIC EMR navigation and clinical documentation
• Other Licensed Clinical Professional Upon Hire Preferred
• Other Coding Credentials Upon Hire Preferred

This position provides leadership to identify and implement hospital revenue enhancement opportunities. Consistent evaluation and understanding of changing third-party payer regulations is required to support accurate and compliant gross revenue capture for assigned service lines and hospital locations. The various hospital CDMs (charge description master) will be maintained with current and accurate revenue codes, CPT/HCPCS codes along with standardized descriptions and billing categories.

The current gross revenue exceeds one billion dollars annually from the Tri Health hospital CDMs. This position requires working collaboratively across all of the revenue cycle, clinical areas, and purchasing to meet gross revenue targets. Coordination with various IT clinical analysts is required to implement charge capture tools that are accurately maintained and that are user friendly. Hospital services are analyzed annually for formulation of pricing strategies.

• Provides leadership to identify and implement hospital revenue enhancement opportunities.
• Acts as a liaison, consultant and educator for hospital charge capture to leadership, clinical teams, charge entry team members, IT, billing, and purchasing.
• Maintains accurate and compliant CDM.
• Regularly reviews vendor CDM data scrubber's compliance reports for assigned service areas and hospital locations and takes necessary action to maximize compliant billing and reimbursement.
• Collaborates with leadership and clinical teams on annual strategic pricing to meet gross revenue targets.
• Actively develops with IS liaison, specific Revenue Integrity revenue guardian checks, claim edits, and work queue rules.
• These revenue validation tools ensure timely billing and accurate reimbursement.
• Facilitates development, implementation and provide monitoring of operational charge capture processes that meet regulatory compliance and that are effective for end-users.

• Bending -
• Climbing
  - Rarely
• Concentrating -
• Continuous Learning -
• Hearing:
  Conversation
  - Consistently
• Hearing:
  Other Sounds
  - Frequently
• Interpersonal Communication -
• Kneeling
  - Rarely
• Lifting