Details

　　Department: Revenue Cycle Management

　　Schedule: Full Time/Day Shift-/M-F no holidays. Flexible day shift.

　　Hospital: 99% remote (Michigan Corporate Services)

　　Location: Warren, MI

　　Benefits

　　Paid time off (PTO)

　　Various health insurance options & wellness plans

　　Retirement benefits including employer match plans

　　Long-term & short-term disability

　　Employee assistance programs (EAP)

　　Parental leave & adoption assistance

　　Tuition reimbursement

　　Ways to give back to your community

　　*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

　　Responsibilities

　　Coordinate payer denials and appeals, respond to insurance company requests for medical records, and perform medical record reviews.

　　Review medical records to determine accuracy of billing through verification of coding, billing and supporting clinical documentation.

　　Coordinate all activities associated with insurance carrier audit requests and work with payers to ensure timely handling of these payer audits.

　　Review technical payer denials and determine whether an appeal is justified. Write and track technical appeal letters and relay information with billing department.

　　Conduct audits to ensure accurate charge capture, enhance reimbursement and identify savings potential.

　　Requirements

　　Licensure / Certification / Registration:

　　Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required.Education:

　　Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.Additional Preferences

　　Bachelors in Nursing (BSN) preferred.

　　Experience in medical record review, billing and coding accuracy and insurance carrier audit request.

　　Knowledge of billing and charging rules as it related to clinical services is a plus.

　　Computer skills (word processing, spreadsheet, graphics, and database software applications, especially Google Workspace). High level of comfort and ability to utilize and understand computer technology

　　Proficient in the medical record: Review, clinical record information systems (Cerner a plus), and some coding methodologies. Ability to understand and interpret medical records, hospital bills, and the charge master. Ability to spot “red flags” on medical bills and records

　　Ability to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies

　　3-5 years experience in hospital nursing, especially in one or more of the following areas: OR, L&D, Neuro-Surg, IR, ICU, ER, Ortho, Endo, Cardiac Cath, ICU, OR L&D, Neuro-surgery, Radiology, Interventional Radiology, ER and ability to understand all ancillary department functions.

　　Experience in UR is a plus

　　Understanding of CPT and ICD-10 codes and Medicare guidelines.

　　Credentials in financial auditing or coding a plus

　　Tasked with reviewing medical records and rendering independent, appropriate, well-supported, and thoroughly-documented defenses when appropriate.

　　Expected to research updates in current medical billing and coding processes and terminology specific to audit processes, clinical procedures, disease states, and other topics as indicated.

　　Tasked with administrative duties as well as charge auditing and intake of payer requests and letters, including calling payers and accessing portals when needed.

　　Conducts concurrent and retrospective claim audits to assure adherence to CMS and other payer guidelines.

　　Communicates timely with Manager required regarding illness, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.

　　Complies with department standards regarding productivity and audit quality.

　　Why Join Our Team

　　Ascension Michigan operates 16 hospitals and more than 300 related healthcare facilities that together employ nearly 23,000 compassionate associates. When you join our care teams, you join a team dedicated to providing spiritually centered, holistic care which sustains and improves the health of the communities we serve throughout Michigan.

　　Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

　　Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

　　Equal Employment Opportunity Employer

　　Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

　　For further information, view the EEO Know Your Rights (English) (https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRights_10_20.pdf) poster or EEO Know Your Rights (Spanish) (https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRightsSp_10_20.pdf) poster.

　　As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

　　Pay Non-Discrimination Notice (https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf)

　　Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

　　E-Verify Statement

　　This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

　　E-Verify (https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf)