Conducts audits of hospital bills for DMC subsidiaries. Defends charges (revenue) challenged by third-party insurance companies, ensures documented charges are correctly billed and billed charges are documented in the medical record. Proposes corrective action in charge capture problem areas. Participates in clinical operational reviews. 1. Conducts audits of commercial insurance billing statements and the respective medical records. 2. Recognizes, documents through research and review and recovers undercharges and adjusts overcharges on billing statements. Submits all adjustments to patient accounting for rebilling. 3. Defends charges (revenue) challenged by third-party insurance companies through audit research, documentation and negotiations. 4. Proposes corrective action in charge capture problem areas; conducts in-service training sessions for hospital personnel to improve charge capture and cost effectiveness, and to reduce the likelihood of charges being challenged by third-party auditors. 5. Analyzes results, identifies trends and patterns and prepares monthly statistical and narrative reports for various levels of hospital management. Such reports include unrecorded and unsupported revenue, and observations and recommendations regarding charge capture, documentation and revenue enhancement. 6. Participates in clinical operational reviews with non-nurse members of the audit staff. 7. Prepares audit reports and presents findings to management.
1.Bachelor's Degree in Nursing. 2.Licensed Registered Nurse in the State of Michigan 3.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. 4. Charge audit or similar experience preferred.
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Internal Number: 1905036227
About DMC Harper University/Hutzel Women's Hospital
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.