Senior Clinical Auditor

Senior Clinical Auditor

Embark on a rewarding career with DMC Detroit Receiving Hospital. If you are a compassionate healthcare professional eager to contribute to patient care, this is your opportunity where your skills make a difference every day. Join us in delivering exceptional healthcare with a personal touch.

Benefit Statement

At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.

Note: Eligibility for benefits may vary by location and is determined by employment status.

Job Summary

Under limited direction and according to established policies and procedures conducts audits of hospital bills and medical records. Ensures documented charges are correctly billed and billed charges are documented in the medical record. Corrects billing errors in the Patient Accounting system and in some cases, the Cerner system. Identifies, reports and recommends actions to improve charge capture processes. Identifies new services and technology in the clinical setting and facilitates establishment of new charges. Conducts in-service training for hospital personnel to ensure understanding of the importance of effective charge capture and documentation of services performed. Conducts complex reviews of departmental processes which include registration, clinical activities, documentation and charge capture. Identifies opportunities to maximize billing in accordance with federal and state regulations. Safeguards the assets of the DMC, advocates appropriate levels of internal control and promotes operating effectiveness and efficiency. Defend the hospitals revenue through research, documentation and negotiation by participating in and acting as a content expert for the hospital in audits conducted by third parties including, but not limited to, Blue Cross Catastrophic audits; HOPP audits; MPRO audits and all commercial insurance audits. Provides both clinical and technical/billing expertise and acts as liaison and resource for user departments. Analyzes results, identifies trends and patterns and prepares monthly statistical and narrative reports for various levels of hospital and corporate management.

Qualifications

Minimum Qualifications: 1.Bachelor's Degree in Nursing. 2.Licensed Registered Nurse in the State of Michigan. 3. Three years of patient care experience in a hospital as a Registered Nurse, at least one of which should be in a critical patient care specialty area such as I.C.U., E.R. or O.R. 4.Charge audit or similar experience preferred. 5. One year experience as a Clinical Auditor. Facility Description DMC Detroit Receiving Hospital, Michigan's first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the state's leading 24/7 hyperbaric oxygen program, Metro Detroit's first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations

Job

Audit

Primary Location

MI-Detroit

Hospital/Facility

Detroit Medical Center Shared Services Job Type : Full-time Shift Type : Days

Tenet Healthcare Corporation