RN-Charge Auditor

– Department: Revenue Cycle Management – Schedule: Full Time/Day Shift-/M-F no holidays. Flexible day shift. – Hospital: 99% remote (Michigan Corporate Services) – Location: Warren, MI Coordinate payer denials and appeals, respond to insurance company requests for medical records, and perform medical record reviews. – Review medical records to determine accuracy of billing through verification of coding, billing and supporting clinical documentation. – Coordinate all activities associated with insurance carrier audit requests and work with payers to ensure timely handling of these payer audits. – Review technical payer denials and determine whether an appeal is justified. Write and track technical appeal letters and relay information with billing department. – Conduct audits to ensure accurate charge capture, enhance reimbursement and identify savings potential.

Licensure / Certification / Registration: – Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required. Education: – Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. – Bachelors in Nursing (BSN) preferred.- – Experience in medical record review, billing and coding accuracy and insurance carrier audit requests. – Knowledge of billing and charging rules as it relates to clinical services is a plus. – Computer skills (word processing, spreadsheet, graphics, and database software applications, especially Google Workspace, MS Office Suite).- High level of comfort and ability to utilize and understand computer technology – Proficient in the medical record:- Review, clinical record information systems (Cerner/Epic a plus), and some coding methodologies. Ability to understand and interpret medical records, hospital bills, and the charge master.- – Ability to spot -red flags- on medical bills and records – Ability to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies – 3-5 years experience in hospital nursing, especially in one or more of the following areas: OR, L&D, Neuro-Surg, IR, ICU, ER, Ortho, Endo, Cardiac Cath, ICU, OR L&D, Neuro-surgery, Radiology, Interventional Radiology, ER and ability to understand all ancillary department functions.- – Experience in UR is a plus – Understanding of CPT and ICD-10 codes and Medicare guidelines.– – Credentials in financial auditing or coding a plus Tasked with reviewing medical records and rendering independent, appropriate, well-supported, and thoroughly-documented defenses when appropriate. – Expected to research updates in current medical billing and coding processes and terminology specific to audit processes, clinical procedures, disease states, and other topics as indicated. – Tasked with administrative duties as well as charge auditing and intake of payer requests and letters, including calling payers and accessing portals when needed. Conducts concurrent and retrospective claim audits to assure adherence to CMS and other payer guidelines.- – Communicates timely with Manager required regarding illness, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues. – Complies with department standards regarding productivity and audit quality.

Additional Information

Organization: Henry Ford St. John Providence

Department: Revenue Cycle Mgmt 001

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

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees 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.