Clinical Revenue Specialist

Come join TriHealth as a Clinical Revenue Specialist!!

At TriHealth, you’ll join a mission‑driven health system where your expertise directly strengthens the financial integrity that supports exceptional patient care. We foster a culture built on collaboration, accuracy, and ethical practice, giving you the opportunity to work closely with clinical teams, Revenue Integrity, Internal Charge Audit, IT, billing, and purchasing. Your work ensures compliant charge capture, optimized reimbursement, and the operational excellence that keeps our hospitals strong.

TriHealth is committed to your growth, offering opportunities to expand your skills in CDM management, revenue cycle operations, and EPIC conversion initiatives as our system continues to evolve. You’ll be part of an innovative, supportive environment that values your contributions, invests in your development, and empowers you to help shape the future of healthcare operations.

Apply today and grow your career with a team that truly values you.

Location

• Work from Home

Work Schedule

• Full-Time (80 hours bi-weekly)

• Day Shift

• No Weekend, Holiday or On Call Commitment

Benefits

TriHealth offers a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page https://careers.trihealth.com/what-we-offer/benefits

Job Requirements

• Associate’s degree or Diploma in Healthcare

• An associate degree in healthcare, finance or coding or nursing or a diploma in nursing is minimum education requirement

• An overall understanding of hospital charging/billing and reimbursement methodologies which includes understanding of CPT/HCPCS code sets Strong Microsoft Office Excel skills

• 3-4 years’ experience Professional Healthcare

Job Overview: This position will review assigned hospital services annually to support formulation of pricing strategies and monitor pricing and charge capture for TriHealth hospitals in conjunction with the Revenue Integrity and Internal Charge Audit departments. The Clinical Revenue Specialist will also perform pre-billing financial audits of medical record documentation by comparing the documentation to detailed hospital account transactions. Detailed findings of charge error trends will be reported to clinical department management. This position acts as a liaison for hospital charge capture to clinical teams, charge entry team members, IT, billing, and purchasing. CDMs (charge description master) will be maintained with current and accurate revenue codes, CPT/HCPCS codes along with standardized descriptions and billing categories. This position will lead revenue cycle functions for CDM conversions to EPIC for any new acquired hospital-based entities.

Job Requirements

• Associate’s degree or Diploma in Healthcare

• An associate degree in healthcare, finance or coding or nursing or a diploma in nursing is minimum education requirement

• An overall understanding of hospital charging/billing and reimbursement methodologies which includes understanding of CPT/HCPCS code sets Strong Microsoft Office Excel skills

• 3-4 years’ experience Professional Healthcare

Job Responsibilities

• Maintains accurate and compliant CDM.

• Regularly reviews vendor CDM compliance reports for assigned service areas and hospital locations and takes necessary action to maximize compliant billing and reimbursement.

• Actively reviews and resolves revenue guardian checks, claim edits, and work queues as assigned.

• These revenue validation tools ensure accurate, timely billing and accurate reimbursement.

• Performs pre-billing financial audits of medical record documentation by comparing the documentation to detailed hospital account transactions.

• Monitors charge capture processes and assist clinical departments, Revenue Integrity and Internal Charge Audit to ensure timely and accurate hospital charge capture.

Other Job-Related Information: Working Conditions: Climbing - Rarely Concentrating - Consistently Continuous Learning - Frequently Hearing: Conversation - Frequently Interpersonal Communication - Frequently Kneeling - Rarely Lifting Serve: ALWAYS… • Welcome everyone by making eye contact, greeting with a smile, and saying "hello" • Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist • Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS… • Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met • Offer patients and guests priority when waiting (lines, elevators) • Work on improving quality, safety, and service

Respect: ALWAYS… • Respect cultural and spiritual differences and honor individual preferences. • Respect everyone’s opinion and contribution, regardless of title/role. • Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS… • Value the time of others by striving to be on time, prepared and actively participating. • Pick up trash, ensuring the physical environment is clean and safe. • Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS… • Acknowledge wins and frequently thank team members and others for contributions. • Show courtesy and compassion with customers, team members and the community