Lead Auditor, Payment Integrity - Health Alliance Plan - Troy (full-time)
EDUCATION/EXPERIENCE REQUIRED
- Bachelor’s degree in Business Administration, Economics, Health Care, Finance, Information Systems, Statistics or other related field and/or relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in claim audits or medical record audits.
- Coding credential from AHIMA or AAPC (i.e., CCS, CCS-P, RHIA, RHIT, CPC, etc.) preferred
- ICD-10-CM Certified preferred
- Minimum of seven (7) years progressive experience in healthcare or managed care/insurance related setting with specific exposure to provider contracting and reimbursement data and methodologies as well as case management, disease management, patient/member data, and fraud, waste, and abuse.
- Minimum two (2) years of experience in leading projects as a project lead and/or lead subject matter expert.
- Demonstrated experience with technical coding concepts and a strong understanding of fraud, waste, and abuse.
- Demonstrated experience analyzing and reviewing fraud, waste, and abuse reports.
- Advanced coding knowledge with practical application.
- Excellent analytical, problem solving, verbal and written skills to communicate complex ideas.
- Excellent skills with the ability to integrate and co-relate information from different domains and subject areas.
- At least three (3) years of experience in lead or supervisory/management position preferred.
- Strong team player with a high level of integrity.
- Flexible, self-driving, resourceful, highly focused and high attention to detail.
- Knowledge of medical claims data and managed care membership data
- Knowledge of health plan reimbursement methodologies.
- Advanced technical skills, which includes, but is not limited to MS Access and Excel, ICD-9, ICD-10 CPT, HCPCS and/or other statistical software.
- Knowledge of Medicare and Medicaid Reimbursement methodologies a plus
- Ability to navigate HAP systems, including Oracle, Facets, and other similar software.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System 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.