Perform complex prospective, concurrent and retrospective audits of medical records for compliance with CMS and other third party payer regulations to determine the accuracy of CPT, HCPCS, ICD-9 and 10 DRG coding, CCI edits and documentation. Conduct operational health care related audits which provide verification of operating policies and procedures.
Analyze audit findings and provide ongoing educational support to appropriate UMHS administrative and coding personnel. Provide regular reports, both verbal and written, to Director of Compliance Auditing & Monitoring and to the department audited on audit results, documentation issues, and education sessions. Conduct or assists in scheduled and non-scheduled compliance audits of outpatient and inpatient services or as requested by the UMHS Compliance Committee, UMHS Audit Subcommittee or UMHS Compliance Office personnel or the Office of General Counsel.
Prepare audit reports which document all audit procedures and findings. The audits will include, but are not limited to, monitoring of coding accuracy and documentation adequacy through regular audits of potential areas of risk and ensuring compliance with laws, rules and regulations. The reporting will include regulation description and detailed description of audit procedures performed findings (graphs, spreadsheets and/or documents) and recommendations for improvements based upon the nature of the audit findings.
Conduct entrance/exit meetings and consult with departments audited on issues, recommendations and action plans. Perform follow up reviews to determine the status of the implementation of accepted recommendations. Provide input into the annual audit plan, specifically in regards to Compliance issues, such as coding, documentation and policy implementation. Understands the financial, operational, and compliance risks that affect the health system.
Compare coding and reimbursement profiles with national and regional norms to identify variations requiring further investigation. Serve as a resource for department managers and coders, staff, physicians and administration to obtain information on accurate and ethical coding as well as documentation standards, guidelines and regulatory requirements. Conduct educational sessions for all clinical staff and support staff on documentation and implementation of CMS and other third party payer regulations. Collaborate with providers and other auditing staff, including but not limited to professional fee billing auditors, and give ongoing feedback on coding and medical record documentation issues.
Maintain current knowledge of new developments relating to coding issues in healthcare. Collaborate with IT staff to assist in the design, functional ability and placement of medical record documentation templates, coding aids and dictation prompts for clinicians and support staff. Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity. Conduct trend analyses to identify patterns and variation in coding practices. Attend meetings as directed by the UMHS Chief Compliance Officer or Director of Compliance Auditing & Monitoring. Perform additional duties as assigned.
Bachelor’s degree in Healthcare, Healthcare Administration, or other related field and or combination of education and related experience .
8-10 years of health care auditing and coding experience in an academic healthcare setting.
A professional certification such as CHC, CHCA, CPC, RHIA, RHIT, is required.
Considerable knowledge in HIPAA, HiTECH, State and Federal Privacy Regulations.
Possesses a working knowledge of UMHS policies and procedures, its business processes, policies and procedures, governance practices, and regulatory requirements so as to effectively conduct audits and monitoring reviews for various Departments throughout the institution.
Has the ability to make independent decisions on matters of significance, free from immediate direction, within the scope of responsibilities.
Must be flexible and able to change priorities quickly with the capacity of handling multiple tasks.
Possesses a working knowledge of best business processes, governance practices, and regulatory requirements so as to effectively conduct audits and monitoring reviews for various Departments throughout the institution.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 153946
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.