Childrenâ��s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Childrenâ��s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Childrenâ��s Hospital of Michigan, Childrenâ��s Hospital of Michigan - Troy and six ambulatory sites.
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. Bachelorâ��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.
Primary Location: Detroit, Michigan
Facility: DMC Children's Hospital of Michigan
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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 Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.