HEALTH INFORMATION MANAGEMENT ANALYST II - COMPLIANCE AND AUDITING
University of Michigan - Ann Arbor
Location: Ann Arbor, Michigan
Internal Number: 242295
Utilize the EPIC Release Module to locate, analyze, and produce medical records required to substantiate Hospital and Professional Billing claims in response to payer, auditor, and government agency requests.
Process medical record requests for on-site regulatory audit requests for CMS (Centers for Medicaid/Medicare Services), OIG (Office of Inspector General), The Joint Commission, and related entities to ensure appropriate follow-through and assist in the minimization of hospital liability. Provide medical records to internal customers, such as the Office of General Counsel (OGC), the Office of Patient Relations and Clinical Risk, Utilization Review Management, and Revenue Cycle as requested or required. Process requests for required medical records within designated time limits.
Represent the unit professionally and provide support and customer services to all internal and external record review requesters.
Provide medical records to the Office of General Counsel (OGC), the Office of Patient Relations and Clinical Risk, Utilization Management, and Revenue Cycle departments upon request
Coordinate "Legal Lock Up" process with the Office of General Counsel
Perform medical record release tracking related to audits and appeals activity in the MiChart Audit and/or MiChart Release of Information modules as appropriate and directed
Verify and process "Authorization to View" form requests from health system employees
Provide assistance to remote auditors as requested (or other users as defined and approved) in accessing the electronic health record via the ECL (EpicCare Link) Provider Portal
Prioritize and respond to medical record requests to meet all time and documentation requirements
Work with other Michigan Medicine staff using existing process standards to ensure that documentation necessary to support appropriate billing is in the record and available to auditing staff for review
Ability to identify and communicate nuances and/or trends in incoming requests for medical records.
Work under fast-paced circumstances to meet deadlines
Identify issues and make recommendations for resolution and improvement
Communicate with unit leadership regarding process and procedures
Assist with development, revision and maintenance of unit training materials, policies, and procedures
Demonstrate an understanding of university, departmental, and unit policies and procedures and seek clarification as needed
Comply with regulatory, legal, and accreditation requirements and seek clarification if needed
Assure compliance with safety programs
Participate in and demonstrate an understanding of the Michigan Quality System/Continuous Quality Improvement and apply Lean Thinking concepts in daily work
Demonstrate initiative by continuous expansion of knowledge and skills
Participate in departmental/unit activities including, but not limited to, staff meetings and in-services
Interact with and advise personnel from the Office of Patient Relations and Clinical Risk, Professional Services, the Office of General Counsel, and specialty departments to ensure requests for medical records are fully resolved
Resolve customer requests in accordance with governmental regulations and Michigan Medicine policies and procedures
Work in collaboration with the release of information vendor, satellite clinics, and the Document and Record Management Unit to ensure all requested records are available online or for delivery to internal and external requesters within required time frames
Work in partnership with Revenue Cycle employees to process requests for medical records and supporting documentation to substantiate claim payment audits and/or appeals.
PERCENTAGE OF DUTIES
Identify and produce electronic and/or paper medical records for auditors, payers, and regulatory requirements under predetermined timelines (including legacy source systems). 70%
Participate in unit-specific, department-wide, or UMHS-initiated process improvement efforts. 10%
Partner with other Revenue Cycle colleagues (e.g., Hospital Billing, Audits and Appeals) to ensure complete and timely production of medical records. 5%
Coordinate remote record reviews; provide system access and training and assist remote auditors. 5%
Certify the accuracy of medical record information for legal certification. 5%
Identify issues/make recommendations or improvements. 5%
1 year of experience using an electronic health record (e.g., EPIC) and administrative systems
Ability to read and understand complex medical documentation is required
Knowledge of general healthcare audit management practices is required
Ability to work independently or in a team with minimal supervision is required
Ability to assess and extract appropriate clinical information from a patient's medical record is required.
Knowledge of medico-legal aspects of health information management, medical terminology, medical treatment methods, pharmacology, patient care assessment, medical documentation requirements, and data collection techniques is required
Considerable experience with Windows computer environment and proficiency with MS Office is required
Knowledge of The Joint Commission standards, CMS regulations, and other regulatory agency requirements
Maintaining active certification and American Health Information Management Association membership is required (as applicable)
Associates Degree in Health Information Technology or Bachelor's Degree in Health Information Management or Healthcare Administration desired
Certified Revenue Cycle Representative certification through the Healthcare Financial Management Association) desired
Knowledgeable of Revenue Cycle processes including billing, insurance and/or coding practices
Experience working with insurance companies and third-party payers is desired.
Understanding and ability to interpret medical terminology and insurance benefit information is desired
Certification as a Registered Health Information Administrator (RHIA) or a Registered Health Information Technician (RHIT) through the American Health Information Management Association (AHIMA) or an equivalent combination of education, professional certification, and experience is desired
WORK LOCATION AND STANDARD HOURS
Standard business hours Monday through Friday between 7:30 AM and 4:00 PM. Flexibility to scheduled hours upon supervisor approval.
Hybrid training is required for this position and will take place onsite at the KMS location and remotely via Microsoft Teams and/or Zoom
This is a primarily remote position once training is completed, and performance-based competency has been achieved.
General supervision is received from the Revenue Cycle Mid-Service, HIM Supervisor of Compliance and Auditing
AHIMA CORE MODEL COMPETENCIES MET
Functional Component of the HIM Professional Core Model
Data/Information Analysis, Transformation, and Decision Support
This component requires the development and implementation of standard practices, policies, and procedures that enable reliable and effective analysis, transformation, and reporting of data and information.
Transforming data and information into knowledge is critical for patient care, improving healthcare quality, advancing research and supporting operations.
Clinical Data Analyst, Data Quality Analyst, Health Data Analyst
Functions (relative to role)
Evaluate the integrity and comparability of data and identify gaps in data sources
Analyze and transform data / information / knowledge / intelligence to generate findings for clinical, financial, operational, research, legal, and regulatory/policy processes and decisions
Compliance with mandated reporting requirements
Information Governance and Stewardship
Information governance provides a foundation for the other data-driven functions in the Core model by providing parameters based on organizational and compliance policies, processes, decision rights and responsibilities. Governance functions and stewardship ensure the use and management of health information complies with jurisdictional law, regulation, standards, and organizational policies. As stewards of health information, HIM roles and functions strive to protect and assure the ethical use of health information.
Functions (relative to role)
Ensure compliance with jurisdictional laws and regulations, reimbursement/payer policies, and legal requirements pertaining to health information.
Manage access, disclosure, use, and control of protected health information.
Decrease risk litigation based on appropriate retention of data.
Increased compliance with current laws and regulations.
Decreased liability and enhanced reputation through reduction of breaches.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.