Senior Clinical Auditor

Detroit Medical Center; Detroit (MI); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) retirement plan with match

Paid time off (PTO)

Professional development opportunities

Health Savings Account

Job summary

DMC Detroit Receiving Hospital is seeking a dedicated healthcare professional to perform audits of hospital bills and medical records, ensuring accurate billing and documentation across the Revenue Cycle.

Responsibilities include identifying errors, guiding charge capture improvements, and training staff on compliant documentation. The role requires nursing credentials and auditing experience to defend hospital revenue in audits by third parties.

Qualifications

• Bachelor's Degree in Nursing is required.
• Licensed Registered Nurse in the State of Michigan.
• Minimum 3 years of patient care experience in a hospital setting as an RN, with at least one year in critical areas (ICU, ER, or OR).
• Charge audit or similar experience preferred.
• One year experience as a Clinical Auditor.

Responsibilities

• Audit hospital bills and medical records under direction and established policies.
• Ensure charges are correctly billed and documented in the medical record and billing systems.
• Identify errors and propose actions to improve charge capture processes.
• Conduct in-service training related to charge capture and documentation.
• Prepare monthly statistical and narrative reports for management and external audits.

Education

Bachelor's Degree in Nursing

Tools

Job description

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. [BRASSRING IMPORT 11/11/16]

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 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: http://www.uscis.gov/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: Detroit Medical Center Shared Services

Job Type: Full Time

Shift Type: Day