Clinical Auditor

Overview DMC Sinai-Grace Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients. Benefits 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 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 care, childcare, auto and 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 hospital’s 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 Bachelor's Degree in Nursing. Licensed Registered Nurse in the State of Michigan. 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. Charge audit or similar experience preferred. One year experience as a Clinical Auditor. Facility Description DMC Sinai-Grace Hospital is DMC’s largest hospital, offering a comprehensive heart center, cancer care, gerontology, emergency medicine, obstetrics/gynecology and cosmetic services. Sinai-Grace’s joint replacement program features a revolutionary minimally invasive knee and hip replacement surgery that attracts patients from all over the country. Sinai-Grace operates more than 21 outpatient care sites and ambulatory surgery centers throughout Wayne and Oakland Counties and is one of 10 hospitals in the nation to be awarded a Robert Wood Johnson Foundation grant to help set the standards of cardiac care for hospitals and physicians throughout the nation. 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: HIM/Coding/Transcription Primary Location: Detroit, Michigan Facility: DMC Sinai-Grace Hospital Job Type: Full Time Shift Type: Day #J-18808-Ljbffr Detroit Medical Center