Job Summary
The Revenue Cycle Compliance & Education (RCE) Office assists providers and departments to ensure their compliance with applicable laws, rules, regulations, policies and procedures related to documentation and coding guidelines. RCE staff are responsible for assisting employees with billing compliance issues and maintaining the Revenue Cycle Compliance Workplan, performing provider education, monitoring and analyzing federal regulations, and developing educational materials. RCE staff work closely with UMHS Compliance, Health System Legal Office and Health Information Management.
Mission Statement
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.
Responsibilities*
Ensures conformance with applicable laws, regulations and Medicare/Medicaid reimbursement rules to ensure UMHS is in compliance with federal, state and/or local regulations. Monitors, analyzes and reports on laws, regulations, audits and industry standards that impact the organization.
Develops and maintains Professional and Hospital billing issues on the Revenue Cycle Compliance Work Plan. Reviews the OIG Work Plan, recent payer audits (including OIG Reports), industry communications and other resources to establish and prioritize.
Recommends appropriate actions based on findings.
Responsible for reviewing, writing and updating Revenue Cycle Billing policies and procedures to ensure that the Revenue Cycle operations are in compliance with all federal and state regulations, payer rules and other reimbursement requirements.
Works with Revenue Cycle Management and other staff to investigate compliance issues. Participates, leads and collaborates with members of Revenue Cycle Billing Policy/Compliance work groups to address compliance and billing operations issues. Coordinates/collaborates on the response to OIG subpoenas or other government agency subpoenas.
Collaborates with other health system units including but not limited to Health System Legal Office, UMHS Compliance Office and Office of Clinical Affairs to ensure appropriate communication on regulatory issues.
Responds to inquiries from billing units and clinical departments regarding compliance issues. Investigates and issues reports on identified compliance issues. Provides staff support to Revenue Cycle Compliance & Education Committee (RCEC). Monitors laws, regulations and standards that impact the organization. Provides education on applicable rules and regulations and to improve operational process.
Provides clinical and operational expertise for the RCE team. Serves as a department expert on third-party payer issues, including working closely with the Revenue Cycle Third Party Payer staff to ensure compliance with rules, regulations and contractual obligations.
Ensure the Revenue Cycle policies on internal and external websites are up to date. Serves as the lead for all Non-Physician Practitioners (NPP) billing and documentation issues and projects including reviewing changes to NPP requirements by payers.
Works with the lead Physician Assistant, the Ambulatory Care lead for Nurse Practitioner issues and UMHS Nursing.
Required Qualifications*
- Bachelor's degree in Health Information Management, or other healthcare- related field
- Certified in Healthcare Compliance through HCCA or Certified in Professional or Hospital Coding through AAPC or RHIA or RHIT
- 5 years of either coding experience for inpatient and outpatient records, or revenue cycle management or equivalent work experience
- Knowledge of ICD coding classification systems
- Working knowledge of coding for third-party payers, including CMS guidelines and reimbursement compliance
- Knowledge of health information systems and database technology
- Able to communicate effectively with team members and management
- Detail-oriented, good organizational skills, analytical, strong problem solving/investigative skills, and ability to be self-directed
- Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect)
- Demonstrate personal integrity, enthusiasm and empathy to internal and external customers
Desired Qualifications*
- Master's degree
- Formal course study in Human Anatomy and Physiology, ICD and CPT coding, and Medical Terminology
- 2-5 years of professional experience as a coding/HIM manager or documentation specialist in a hospital or health system or revenue cycle management
- Knowledge of HIPAA and other compliance requirements
- Knowledge of MiChart (Epic)
- Knowledge of University policies and procedures
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Background Screening
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. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.