Henry Ford Health System Revenue Integrity Auditor in Detroit, Michigan

GENERAL SUMMARY:

Reporting to the Manager, Revenue Integrity, the Revenue Integrity (RI) Auditor must have a comprehensive understanding of medical terminology, coding, charge entry, and revenue cycle processes. The RI Auditor provides support for timely, accurate and inclusive charge capture, coding assignments, billing functions and revenue routing through evaluation of payer updates, performance of record audits, presentation of staff education and other related activities. With minimal supervision, the RI Auditor plans and performs audits and identifies operational, financial, compliance and other findings in order to make appropriate conclusions and determine next steps and needed communications. Works collaboratively with RI Team to identify charge system (including clinical system) weaknesses, recommends changes and provides education.

The RI Auditor must approach problem-solving challenges independently, have strong attention to detail and enjoy working in a fast-paced, collaborative team-based environment. The RI Team is responsible for department charge audits and data analytics, ability to investigate and resolve charging and coding issues, as well as staying abreast of all changes related to billing/coding compliance. The RI Auditor coordinates processes between clinical operations and revenue cycle departments ensuring that the accounts audited reflect proper documentation, charge capture, coding and billing to support proper payment. The RI Auditor also confirms that the charges are routed to the appropriate department/cost center. Audits will be assigned for encounters falling within the IP, OP, and ED areas, for both hospital and professional services with the expectation that this person understand hospitals payer contracts, and reimbursement methodologies. This person will assist the RI Team with running revenue reports on a daily basis, and will explore possibilities of “revenue leakage” in any targeted areas identified thru the audit process.

This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Leads audits according to RI Team Tracer Audit Methodology. Meets with departmental leadership to review findings, documentation standards and recommendations for improvement. Targeted populations are identified through random sampling, focused quarterly reviews, issues identified in collaboration with various HFHS personnel, and rotation/selection of specific clinical areas.

  • Audits include review of selected medical records documentation to determine accuracy of coding assignments, billing compliance, medical necessity and when appropriate collaborate with hospital HIM and financial departments to identify physician and clinic practices that require improved documentation.

  • Analyzes charge capture audit reports to verify that appropriate charges have been posted to patient accounts according to diagnosis and related procedure codes and that revenue has been routed/recorded in the appropriate department/cost center.

  • Identifies charge trends and compiles information to determine quarterly focused reviews of specific departments.

  • Performs ancillary service quality assurance reviews and departmental audits, and meets with the department Managers and staff to instruct and inform on documentation findings to increase accuracy; recommends solutions to improve charge capture accuracy.

  • Provides feedback to providers regarding missing, incomplete, unspecific, unclear or conflicting documentation.

  • Provides coding, documentation and compliance guidance as requested.

  • Assists and directly provides training and orientation in group settings as well as one-on-one.

  • Plans and presents in-services to nursing, physician, and clerical personnel regarding processes, updates and reviews relating to audit findings and/or regulatory compliance.

  • Coordinates with RI Specialists and Analysts to complete various inquiries by departments to ensure accurate and timely responses.

EDUCATION/EXPERIENCE REQUIRED:

  • Associate’s Degree. Nursing degree from a recognized nursing program or BSN a plus. Extensive knowledge of CPT, HCPCS, ICD-9, ICD-10 coding systems and a working knowledge of health care compliance are required.

  • Five (5) years coding experience

  • Four (4) years clinical experience or three to five (3-5) years of experience in revenue cycle/audit processes.

  • Hospital billing and finance background strongly encouraged, preferred.

  • Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other HFHS personnel.

  • Knowledge of medical coding (facility and professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related to rules/coverage.

  • Ability to manage large, complex project assignments.

  • Ability to investigate, analyze and resolve issues at a high level.

  • Excellent communication, organizational, analytical and problem solving skills

CERTIFICATIONS/LICENSURES REQUIRED:

  • Certification in related healthcare field.

  • RN or RHIA, RHIT, CCS or CPC required.

    Overview

    Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health

    care systems, is a national leader in clinical care, research and education. The system includes

    the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health

    insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory

    network and many other health-related entities throughout southeast Michigan, providing a

    full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.

    The health system also is a major economic driver in Michigan and employs more than 24,600

    employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The

    health system is led by President and CEO Wright Lassiter III. To learn more, visitHenryFord.com.

    Benefits

    Whether it's offering a new medical option, helping you make healthier lifestyle choices or

    making the employee enrollment selection experience easier, it's all about choice. Henry

    Ford Health System has a new approach for its employee benefits program - My Choice

    Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

    dozens of options for all of our employees including compensation, benefits, work/life balance

    and learning - options that enhance your career and add value to your personal life. As an

    employee you are provided access to Retirement Programs, an Employee Assistance Program

    (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

    and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

    benefits and services.

    Equal Employment Opportunity/Affirmative Action Employer

    Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.