Senior Clinical Revenue Specialist

TriHealth; Cincinnati (OH); Remote; USD 90,000 - 120,000; Full time

Job summary

TriHealth seeks a Sr. Clinical Revenue Specialist to lead hospital revenue integrity, ensuring precise coding, documentation, and compliant billing across CDMs. You will drive ongoing improvements in charge capture and pricing strategies to optimize reimbursement.

You will collaborate across revenue cycle, clinical teams, IT, and purchasing, influence coding decisions, and monitor vendor data to support TriHealth's $1+ billion in annual hospital revenue while upholding patient care excellence.

Qualifications

• Bachelor's degree required.
• 2–3 years experience as licensed clinical professional.
• Working knowledge of HCPCS.
• Knowledge of CPT codes.
• Knowledge of Revenue codes.
• Experience with budget development and RVUs.
• Familiarity with EPIC EMR navigation and clinical documentation.
• Other licensed clinical professional preferred.
• Other coding credentials preferred.

Responsibilities

• Provide leadership to identify and implement hospital revenue enhancement opportunities.
• Act as liaison and educator for hospital charge capture to leadership, clinical teams, charge entry, IT, billing and purchasing.
• Maintain accurate and compliant CDM.
• Review vendor CDM data scrubber reports and maximize compliant billing and reimbursement.
• Collaborate on annual strategic pricing to meet gross revenue targets.
• Develop with IS liaison revenue guardian checks, claim edits, and work queue rules.
• Ensure revenue validation tools support timely billing and accurate reimbursement.
• Facilitate development, implementation and monitoring of charge capture processes meeting regulatory compliance.

Skills

HCPCS

CPT

Revenue codes

RVUs

EPIC EMR

Education

Bachelor's Degree

Tools

EPIC EMR

Job description

Job Description

Join TriHealth as a Sr. Clinical Revenue Specialist! At TriHealth, 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, TriHealth 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.

Location

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

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

• 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

Job Overview

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 TriHealth 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.

Job Responsibilities

• 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.

Working Conditions

• Bending -
• Climbing - Rarely
• Concentrating -
• Continuous Learning -
• Hearing: Conversation - Consistently
• Hearing: Other Sounds - Frequently
• Interpersonal Communication -
• Kneeling - Rarely
• Lifting <10 Lbs. -
• Lifting 50+ Lbs. - Rarely
• Lifting <50 Lbs. - Occasionally
• Pulling - Rarely
• Pushing - Rarely
• Reaching - Rarely
• Reading - Consistently
• Sitting - Frequently
• Standing - Rarely
• Stooping - Rarely
• Talking - Consistently
• Thinking/Reasoning - Consistently
• Use of Hands - Frequently
• Color Vision - Occasionally
• Visual Acuity: Far - Frequently
• Visual Acuity: Near - Consistently
• Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

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