GENERAL SUMMARY:
The Manager of Payor Audit is responsible for managing all third-party payer audit processes across the Henry Ford Health System which includes denial, appeal, and financial tracking. This position will oversee the following: Coordination and aggregation of the medical, billing and coding records and the timely submission of documentation for Medicare Recovery Audit Contractors (RAC) and Third-Party Payer Audits.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
Manages and coordinates in conjunction with the Director on the planning, organizing, implementation and evaluation of the activities and the staff engaged in direct operations of Payor Audit activities.
Coordination of timely submission of audit appeals, follow-up for audit and appeal results, tracking of financial impacts, and audit closure.
Coordination of audit reports to include, but not limited to, financial impact, denial trends, payor scorecards, audit volume and outcomes.
Collaborates with multidisciplinary teams on audit targets and to mitigate future risk.
Working with key revenue cycle and business unit leadership, aids in the development and execution of projects to ensure standardized approach to
successfully navigates the payer audit process.
Develops and assists to oversee strategies for multi-disciplinary projects to ensure the system achieves successful revenue realization in post audit processes.
Assists in the development of dashboards, KPI's, misc. reporting, and other tools to understand and communicate performance to the health system; engages analytical staff in the development of these tools.
Research best practices, including implementation of new products or systems, for and oversees projects to incorporate identified best practices into process design.
Works with staff to assess organizational performance (e.g., a function, a department, a key process, etc.) in relation to established goals and standards; recommends new approaches, policies, and procedures to effect continual progress toward goals and standards.
Develops skills that aid and serve as a resource to departments and business units in identifying, planning, and implementing improvement initiatives with alignment to System goals.
Manages day to day program operations, recruit, hire, and onboard new staff as appropriate.
Assigns, distributes, and reviews work assignments, ensuring timely and accurate completion
EDUCATION/EXPERIENCE REQUIRED:
A Bachelor's degree in business administration, healthcare administration, organizational development, or a similar field. OR Five total years of leadership and/or consultative experience in a healthcare-related field.
Strong leadership/mentoring skills applicable to both inter-departmental staff and multi-disciplinary teams.
Knowledge of Medicare, Medicaid, Blue Cross and other third-party payers billing and reimbursement regulations/policies, preferred.
Demonstrates fluency in healthcare financial management and revenue cycle management best practices.
Exceptional detail orientation and project management skills; ability to estimate time frames and meet projected deadlines; ability to manage large, complex, simultaneous assignments with potentially conflicting priorities and deadlines.
Excellent communicator- able to express complex ideas clearly and effectively to a varied audience, including the ability to teach complex technical/analytical concepts to System leadership, management, and staff.
Foundational knowledge of analytical/technical, facilitative, and process improvement knowledge.
Strong Microsoft Office skills, particularly Excel
Additional Information
Organization: Corporate Services
Department: Ascension Payor Audit CDRU
Henry Ford Health Location: Corporate Services
Shift: Day Job
Union Code: Not Applicable
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services - from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .
Benefits
The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
