Under general direction, provides education and guidance related to compliance and best practices for revenue cycle coding and billing processes to faculty, non-physician providers, residents, clinical department ancillary support staff as well as coding and billing staff. Conducts and coordinates review of healthcare providers on professional fee documentation and coding. Collaborates with the clinical departments and other units to reduce the risk of fraud and to identify revenue opportunities through physician and staff education. Serves as a subject matter expert and liaison for clinical departments in the areas of compliance and best practice related to professional services coding and documentation.
Conduct ongoing cycles of provider documentation reviews to assess compliance risk and identify areas of opportunities for improvement in coding and billing practices. Conduct post-review group and individual training and education.
Develop and present issue-specific and general revenue cycle presentations to large groups, including faculty meetings, provider orientation sessions, etc.
Provide new faculty, advance practice providers, and resident compliance training via on-line training tools and subsequent follow up review.
Research, interpret and communicate applicable laws and regulations, and third-party payer rules.
Develop tools which assist providers with efficient, effective documentation and accurate billing.
Keep providers informed of rapidly changing regulatory and third-party payer billing rules; serve as a liaison with the clinical departments in the areas of coding and documentation for their specialties.
Perform focused analytical documentation and coding reviews to proactively assess compliance and revenue loss risks for areas of concern identified by the Revenue Cycle Compliance and Education office.
Participate in management of the Revenue Cycle compliance work plans, including identifying and assessing issues that create risk for the Health System.
Develop, investigate and present reports on issues to the Revenue Cycle Education Committee (RCEC), administrators, faculty and other key staff.
Collaboration with the Health Information Management (HIM) team on joint projects related to quality measures and best practices in documentation impacting both facility and professional billing.
Two or four-year degree in Health Information Management or other healthcare related field.
Certification as AHIMA RHIA or RHIT, AAPC CPC- or COC or licensed registered nurse.
Three years of experience in professional services coding or equivalent work experience with demonstrated understanding of evaluation and management (E&M), surgery and minor procedure coding, billing and documentation.
Proficiency in medical terminology, anatomy and physiology, ICD-10-CM, HCPCS and CPT-4 coding classification systems.
Working knowledge of coding for third-party payers, including CMS and WPSGHA guidelines and reimbursement compliance.
Demonstrated proficiency preparing and delivering written and oral reports and materials to small and large groups.
Knowledge of HIPAA and other compliance requirements.
Ability to work independently and with a minimal amount of supervision and day-to-day direction; ability to manage time and prioritize multiple tasks effectively; ability to work effectively as part of a multidisciplinary team.
Demonstrate the highest level of professional relationships with a variety of personnel; ability to address sensitive issues in a confidential manner.
Significant flexibility in schedule and occasional travel may be required.
Ability to establish and maintain effective working relationships with providers, clinical department administration and support staff.
Demonstrated behaviors consistent with standards of performance improvement and organizational values
Knowledge of health information systems and database technology.
Detail-oriented, good organizational skills, analytical, strong problem solving/investigative skills. 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).
Certification in healthcare compliance through Healthcare Compliance Association (HCCA).
Completion of college level formal course study in human anatomy and physiology, ICD-10-CM, HCPCS, and CPT coding, and medical terminology.
Extensive professional experience (5+ years) as a coder, auditor, documentation specialist or equivalent in a hospital or health system or revenue cycle management.
Experience performing reviews, analyzing documentation and identifying areas of risk and potential irregularities across the revenue cycle.
Experience interpreting and applying CMS and other third party payer guidelines and regulations, particularly related to professional services and teaching physician rules.
Ability to communicate complex policies and regulations to multiple audiences.
Knowledge of University policies and procedures.
Knowledge of the Michart (EPIC) application 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. 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.
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.
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.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 195844
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.