Director Revenue Cycle Inpatient Clinical Documentation Improvement & Payer Audit

*The Director Revenue Cycle Inpatient Clinical Documentation Improvement & Payer Audit is a Remote OR Hybrid role with Henry Ford Health (HFH). Our HFH office for this position is located in Troy, MI for any Hybrid or Office visit time*

Henry Ford Health (HFH), one of the leading healthcare systems in Michigan, continues to grow and innovate, driven in part by its joint venture with Ascension, launched on October 1, 2024. As we expand, we are seeking a highly skilled and experienced Clinical Documentation Improvement (CDI) Program Director to provide concentrated daily oversight of Inpatient Clinical Documentation Improvement and Payer Audit teams.

The Program Director will partner with clinicians, coders, payers, and other members of the healthcare team to ensure accurate and timely clinical documentation in the medical record. Through collaboration with members of the team and revenue cycle leadership, identifies departmental and business unit priorities, establishes goals, and implements strategies designed to foster a culture of innovation, employee engagement, and exceptional business performance. Role also includes payer collaboration and denials management including oversight of documentation requests both pre and post payment.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Daily Operations

• Continuously surveils industry technology for applicability to all areas of clinical documentation. Partners with leaders from other business units to understand and mitigate barriers.
• Oversight of analysis of employee/operational performance; recommends changes and efficiencies.
• Provides periodic monitoring and analysis of productivity metrics to ensure service standards are being met and individual workflows are appropriate.
• Manages CPT//ICD-10 code usage to ensure accurate, effective, communication with physicians regarding coding trends and accurate coding to maximize reimbursement.
• Collaborates with clinical partners and other stakeholders on documentation improvement strategies. Identifies performance gaps and creates action plans to mitigate.
• Prepares annual budget and manages expenses and staffing levels.
• Recruits and develops leaders, builds a culture of high performance and engaged workforce.
• Participates in data collection for performance measures, investigates opportunities, and implements solutions for optimization.
• Demonstrates belief in the mission of Henry Ford Health through the ability to articulate, interpret, and incorporate its mission into departmental goals and objectives.
• Establishes priorities and long and short-term strategic goals of the department with the assistance of the management team. Ensures staff is aligned with the goals and objectives related to Revenue Cycle for the organization.
• Actively participates in various committees such as, Revenue Cycle Coding Council, Compliance, etc.
• May develop and/or lead committees/teams related to coding or documentation, denials, regulatory changes, performance improvement, and compliance.
• Ensures that information systems support current and future needs of the department.
• Works closely with information technology in transition planning including, but not limited to, testing, installation, and education of staff to produce and maintain high quality data integrity.
• Creates and manages strategic partnerships with vendors and third-party systems to ensure optimization of costs and quality.
• Monitors performance of external vendors with monthly performance metrics and standards compared to benchmarks.
• Ensures concurrent Clinical Documentation Improvement activities are following local, state, and federal guidelines.
• Responsible for leadership within clinical teams to promote documentation standardization for the health system.
• Collaborates with HFHS departments to ensure services performed are charged and posted in a timely and compliant manner.
• Maintains revenue cycle accountability to the business units.
• Oversees/directs the development of policies and procedures for the department.
• Supports the standards set forth in the HFH Code of Conducts by creating an atmosphere of commitment to legal and ethical standards.
• Creates and manages strategic partnerships with on shore and off-shore vendors and third-party systems to ensure optimization of costs and quality.
• Creates a process for escalation of payer opportunities including managed care, legal and other stakeholders.
• Serves as an internal consultant on industry best practice, denials, payer performance, CMS regulations, documentation, and compliance.
• Performs other related duties as assigned.

Compliance

• Responsible for maintaining regulatory compliance with external agencies and state and federal regulations for medical record and coding related standards for each business unit and the health system. Ensures staff is kept informed and educated on process and regulatory changes.
• Assures support services function meets all current regulatory compliance and HIPAA transaction requirements and keeps current with MS-DRG and ICD- 10/CPT coding rules and regulations.
• Works with risk management, legal counsel, and administrative staff, key departments, providers, and committees to ensure that the organization maintains appropriate compliance including privacy and security and confidentiality policies, procedures, forms, coding, and materials that reflect current organizational practices and regulatory requirements at the local, state, and national levels.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor's degree in Health Information Management, Accounting, Business Administration, Finance, or other business related field.
• Five years management experience required.
• Knowledge of best practices related to revenue cycle operations.
• Experience at a large, complex, integrated healthcare organization, preferred.
• Communication skills and the ability to interact effectively with staff.
• Ability to manage, coordinate, and lead simultaneously. Ability to estimate time frames and meet projected deadlines.
• Ability to work with a variety of individuals in executive, managerial and staff level positions.
• Ability to work independently.
• Ability to understand and lead change.
• Goal- oriented, exceptional interpersonal skills, change management and political skill.
• Demonstrate experience in all areas of medical record functions, including privacy & compliance regulations.

CERTIFICATIONS/LICENSURES REQUIRED:

• RN, CPC, CCS, CCS-P, RHIT, or RHIA, preferred.

• Organization: Corporate Services
• Department: Revenue Cycle Administration
• Shift: Day Job
• Union Code: Not Applicable