Position Summary: 

Responsible for leading audit and post pay denial activity received from payers and /or 3rd party auditors. Functional assignments include management of internal and external auditing, customer service, software management, and tracking responses to the Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and Comprehensive Error Rate Testing Contractors (CERT) pre and post payment reviews. Supports Corporate Director with, Auditing, Accounts Resolution and Revenue Cycle in meeting strategic objectives throughout the McLaren System.

Essential Functions and Responsibilities:

Provides leadership throughout the system regarding facility audits, managing external audits and account resolution inquiries.Responsible for managing the daily operations of the audit team and guiding the efficient and effective process for audits & denials of facility claims.Provides leadership for audit staff with training, compliance reviews, regulatory guidance, work distribution, and monitoring of accounts receivable issues related to audits.Ensures audit process and guidelines meet state, federal, hospital, and other external agencies requirements and standards.Develops and implements plans to ensure the achievement of established objectives.Assist with, facilitate, and participates in system and subsidiary level meetingsWorks with clinical and other staff to improve clinical documentation to reduce audit related denials.Assists in writing and maintaining policies, procedures, and training materials related to the audit team.

Qualifications:

Required:

·         High School Diploma

·         Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), or hospital biller

·         5 years’ experience in health care or closely related field

OR

·         Associate degree in Health Information Technology, Nursing, Business Administration, or related field

·         4 years’ experience in health care or closely related field

Preferred:

·         Bachelor’s degree in healthcare related field

·         ACMA or ACDIS memberships

·         Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist, or Certified Clinical Documentation Specialist certifications

Additional Information Schedule: Full-time Requisition ID: 25005565 Daily Work Times: Standard Business Hours Hours Per Pay Period: 80 On Call: No Weekends: No