Overview
On Site
Full Time
Skills
Supervision
Data Integrity
Strategic Planning
Decision Support
Microsoft Exchange
Resource Allocation
Pivot Table
Reporting
Workflow
Change Management
Configuration Management
Content Management
Dashboard
Testing
Data Quality
Distribution
Medicare
Medicaid
Insurance
Incident Management
Cisco ICM
Data Analysis
Leadership
Productivity
Benchmarking
Training
Documentation
Data Collection
Publications
Oracle Linux
Health Care
Management
Utilization Management
Billing
Database
Presentation Software
Job Details
Position Summary:
Under general supervision, facilitates report generation and detailed statistical data compilation from various healthcare applications and outcome reports and/or analysis while maintaining data integrity and quality through system management activities. Provides CM, UM and Denial management data for strategic planning, decision support, outcomes analysis, information exchange, comparative data analyses, resource allocation, credentialing, and health policy decisions.
Essential Functions and Responsibilities as Assigned:
1.Assists clinicians in understanding the use of data for the improvement of practice.
2.Develops and maintains dashboards for ICM leadership and staff, uses pivot tables and graphs to report outcomes to leadership.
3.Maintains and updates specific departmental workflow tools as needed.
4.Provides ad hoc and routine data reports from the CM, UM and Denial dashboards, Premier, Veracity, Optum coding/abstracting system, healthcare applications or other sources. This includes testing data quality prior to submission, reviewing post-submission quality reports and correcting data issues as necessary.
5.Serves as a source of expertise for internal and external sources of data, its validity, methods for data access and information policy issues.
6.Tests, reviews, corrects, and submits monthly data to MHC corporate leadership for distribution to executive and subsidiary McLaren leadership team.
7.Assists in educating ICM team colleagues about complex clinical appeals, utilization review, including role, responsibilities tools, and methodologies.
8.Maintains current knowledge of hospital billing processes, applicable CMS rules and billing regulations related to Medicare, Medicaid, and commercial insurance. Participates in the resolution of retrospective billing issues and standardization processes within ICM.
9.Maintains confidentiality of all information obtained while participating in ICM data analysis activities.
10.Assists leadership in the collection and analysis of clinical productivity benchmarking and assures continuity between benchmarking and other reported patient discrepancies.
11.Provides orientation and training to new department employees related to documentation and data collection necessary for staff to perform.
12.Complies, analyzes, and evaluates quality and clinical data to identify patterns or trends, using statistical process and controls and various databases or software programs.
14.Performs other related duties as required and directed.
Qualifications:
Required
High School Diploma or GED (Must obtain an Associates Degree in healthcare, coding, billing or related field within 3 years of hire)
5 years' experience with payer denials and/or coding/billing related payer denials
OR
Associates Degree in healthcare, coding, billing or related field
3 years' experience with payer denials and/or coding/billing related payer denials
Preferred:
RHIT/RHIA credentials
Experience with databases, spreadsheet software and presentation software
Under general supervision, facilitates report generation and detailed statistical data compilation from various healthcare applications and outcome reports and/or analysis while maintaining data integrity and quality through system management activities. Provides CM, UM and Denial management data for strategic planning, decision support, outcomes analysis, information exchange, comparative data analyses, resource allocation, credentialing, and health policy decisions.
Essential Functions and Responsibilities as Assigned:
1.Assists clinicians in understanding the use of data for the improvement of practice.
2.Develops and maintains dashboards for ICM leadership and staff, uses pivot tables and graphs to report outcomes to leadership.
3.Maintains and updates specific departmental workflow tools as needed.
4.Provides ad hoc and routine data reports from the CM, UM and Denial dashboards, Premier, Veracity, Optum coding/abstracting system, healthcare applications or other sources. This includes testing data quality prior to submission, reviewing post-submission quality reports and correcting data issues as necessary.
5.Serves as a source of expertise for internal and external sources of data, its validity, methods for data access and information policy issues.
6.Tests, reviews, corrects, and submits monthly data to MHC corporate leadership for distribution to executive and subsidiary McLaren leadership team.
7.Assists in educating ICM team colleagues about complex clinical appeals, utilization review, including role, responsibilities tools, and methodologies.
8.Maintains current knowledge of hospital billing processes, applicable CMS rules and billing regulations related to Medicare, Medicaid, and commercial insurance. Participates in the resolution of retrospective billing issues and standardization processes within ICM.
9.Maintains confidentiality of all information obtained while participating in ICM data analysis activities.
10.Assists leadership in the collection and analysis of clinical productivity benchmarking and assures continuity between benchmarking and other reported patient discrepancies.
11.Provides orientation and training to new department employees related to documentation and data collection necessary for staff to perform.
12.Complies, analyzes, and evaluates quality and clinical data to identify patterns or trends, using statistical process and controls and various databases or software programs.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
14.Performs other related duties as required and directed.
Qualifications:
Required
High School Diploma or GED (Must obtain an Associates Degree in healthcare, coding, billing or related field within 3 years of hire)
5 years' experience with payer denials and/or coding/billing related payer denials
OR
Associates Degree in healthcare, coding, billing or related field
3 years' experience with payer denials and/or coding/billing related payer denials
Preferred:
- Experience in denials management, utilization management, coding or billing
- Certified Health Data Analyst (CHDA)
RHIT/RHIA credentials
Experience with databases, spreadsheet software and presentation software
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.