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.

• Associates Degree required. (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 required.

• 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.

• Certification in related healthcare field.

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

Additional Information

• Organization: Corporate Services

• Department: Revenue Integrity

• Shift: Day Job

• Union Code: Not Applicable

  Additional Details

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.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 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 a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.