BASIC FUNCTION AND RESPONSIBILITY
To provide advisory services and assistance to facilitate the response to external audits in support of UMHS business objectives and in compliance with applicable regulatory requirements. Ensure the timely response and submission of requested information and coordination of appeals. Analyze data on audit activity, outcomes, and trends in collaboration with HIM personnel and other stakeholders. Prepare and complete appeals. Perform data collection and analysis in the preparation of appeals.
CHARACTERISTIC DUTIES AND RESPONSIBLITIES
- Identify and address change management issues related to the evolution of the health information environment.
- Analyze insurance reviews and other audit results to determine appropriate appeal strategies. Research audit results to discover trends in reimbursement issues. Determine the extent to which denials need to be investigated and appealed.
- Analyze and abstract information from medical records and audit results into the audit tracking software for data collection, verification of billing practices, and compliance with regulatory agencies and insurance company requirements.
- Coordinate auditor requests for medical records and on-site medical record reviews. Assist in the coordination of appeal responses. Track denials and appeals for data collection and statistical reporting, including data input into the audit tracking system.
- Coordinate all activities related to the external auditing process including the tracking of all incoming requests, submission of requested information and appeals. This includes receiving and validating request for information and documentation with respect to potential or actual denials and referring denials to the appropriate party for research and response.
- Monitor and track any required hand-offs between departments in order to ensure compliance with audit response timelines.
- Coordinate replies from all relevant departments and prepare formal written responses.
- Interact with and educate physicians, clinicians, third party payers, internal and external customers regarding documentation requirements and the appeal process. Provide notification of audit and appeal outcomes to institutional stakeholders.
- Act as a liaison between payers and UMHS physicians and coordinate physician-level appeal conferences.
- Provides assistance in preparation and daily functions for onsite and offsite audits.
- Maintain current knowledge of health information management practices and the electronic health record.
- Demonstrate an understanding of University, departmental, and unit policies and procedures and seek clarification as needed.
- Assure compliance with safety programs.
- Meet the departmental quality standards for work performance.
- Expand job-related knowledge and skills by attending and participating in educational programs and staff meetings.
- Work and communicate effectively with customers and coworkers to accomplish organizational goals.
- Performs special projects and duties as assigned in order to maintain the efficiency of the unit.
- Prepare and provides statistical data regarding third party audits and appeals.
- Identify opportunities to improve UMHS compliance with payer and other auditor regulations to decrease future denials and improve appeal success rates.
- Identify opportunities to improve unit processes to reduce record preparation time and expense.
- Assists in development and design of new processes and systems related to medical record requests and reviews from auditors and third party payers.
- Participate in and demonstrate an understanding of UMHS Continuous Quality Improvement.
- Demonstrate consistent use of LEAN methodology for problem analysis and process improvement.
- Assists management in education and training of unit staff in record request preparation and onsite auditor assistance.
- Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task.
- Data Management: Acquires, validates, and processes data so its accessibility, reliability, and timeliness are ensured to satisfy the needs of end users.
- Analysis: Analytical skills with the ability to visualize, articulate, and solve complex problems and concepts and make decisions based on available information. Ability to analyze detailed information to determine appropriate compliance with privacy and security rules.
- Critical Thinking: Gathers and integrates critical information to arrive at effective solutions.
- Decision Making: Makes timely, informed decisions that take into account the facts, goals, constraints and risks.
Direction is received from the Administrative Specialist Senior, Compliance and Auditing.
Functional supervision may be exercised over Health Information Analysts in Compliance & Auditing.
- Registered Health Information Technician (RHIT) certification or an equivalent combination of education and experience is required.
- Knowledge of standard medical terminology is required.
- Knowledge of treatment methods, patient care assessment, data collection techniques, and coding classification is required.
- Demonstrated ability to collect and analyze medical information is required.
- Ability to work independently with minimal supervision is required.
- Ability to work under pressure and meet deadlines is required.
- Knowledge of TJC standards, CMS regulations, and other regulatory agency documentation requirements is required.
- Strong verbal and written communication skills for interaction with clinicians, third party payers, and staff are required.
- One or more years’ experience in analyzing and interpreting data in a health care related field is required.
- Registered Health Information Administrator (RHIA) or an equivalent combination of education and experience is preferred.
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.
The mission of the University of Michigan is to serve the people of Michigan and the world through preeminence in creating, communicating, preserving and applying knowledge, art, and academic values, and in developing leaders and citizens who will challenge the present and enrich the future. The University of Michigan is committed to foster learning, creativity and productivity, and to support the vigorous exchange of ideas and information, not only in the classroom but in the workplace by:
- Creating a work environment in which people treat each other with respect and dignity, regardless of roles, responsibilities or differences.
- Providing support, direction and resources enabling us to accomplish the responsibilities of our jobs and to reach the goals that are set for professional and personal growth.
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.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.