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

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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

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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

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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.

1. 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

• Bachelor’s degree in healthcare, coding, billing, or related field

• Three years’ experience providing access to and developing data resources for studying clinical and health service processes

• Three years’ experience in coding/documentation and billing regulations related to third party payer denials, primarily RAC-related activities, and commercial appeals

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