Health Alliance Plan (HAP)

Introduction:

Health Alliance Plan (HAP)

Health Alliance Plan (HAP) is a nonprofit, regional health plan based in Detroit, Michigan and a subsidiary of the Henry Ford Health System. We are actively recruiting a Director – Payment Integrity to join our team in our Southfield, Michigan office.  HAP provides health coverage to more than 670,000 members and to companies of all sizes. For more than 50 years, HAP has partnered with leading doctors and hospitals, employers and community organizations to improve the health and well-being of its members. HAP offers a product portfolio with six distinct product lines: Group Insured Commercial, Individual, Medicare, Medicaid, Self-Funded and Network Leasing. HAP delivers award-winning preventive services, disease management, wellness programs and personalized customer service. The National Committee for Quality Assurance has awarded HAP’s commercial HMO and HAP Senior Plus Excellent Accreditation.

Job Description:

General Summary:

Responsible for developing and implementing an analytically driven approach to fraud and abuse identification and prevention.  Responsible for creating and implementing detection, recovery and prevention processes to reduce unnecessary medical expense. Develops and implements the long-term strategy for creation, quantification, and implementation of fraud and abuse services across the company.  This position will be responsible for the day to day operations of the Payment Integrity team to include project assignments, review of reports, and staff developmental issues.  Responsible for ensuring HAP remains in and can demonstrate compliance with all federal and state statutes and contract requirements relating to fraud, waste, and abuse.  Oversees the direct accountability to ensure compliance with federal and state regulations; development, implementation and coordination of all fraud, waste, and abuse activities and program requirements including areas with no direct reporting.

Principal Duties and Responsibilities:

• Provides complete oversight of fraud and abuse initiatives, identifies new opportunities, and provides monthly reporting of successes and barriers. Project manages cross-functional corporate business teams and meetings in the development of fraud and abuse initiatives, baseline targets, and results as they relate to specific corporate strategies and programs.
• Oversight of all fraud, waste, and abuse requirements, including routine audits, reporting to third parties, investigations, education, outreach, publications, and effectiveness reviews.
• Strategic planning and vision of the fraud, waste, and abuse and payment integrity program to ensure HAP is in compliance with federal and state statutes and regulations.
• Makes decisions that have significant and broad impact to cross-sections of the company.
• Advises and assists with the development and implementation of processes to reduce risk to the organization.
• Identify and address potential areas of fraud, waste, and abuse or payment integrity risks.
• Serve as the point person and advocate for fraud, waste, and abuse and payment integrity matters.
• Refine and sustain a mechanism to ensure timely and consistent reporting of fraud, waste, and abuse activities as required by government agencies and federal contracts.
• Oversee and directly accountable for all investigations and audits are conducted as required by law and federal contracts and performed in a continuous and systematic manor.
• Understand and communicate to leadership and the Corporate Compliance Committee the breadth and complexities associated with fraud, waste, and abuse regulatory requirements.
• Maintain a matrix and direct oversight and central reporting of vendors impacting healthcare affordability and medical trend management.
• Assess preparedness for new and emerging fraud, waste, and abuse trends, schemes, and draft regulations.
• Direct and oversee all activities of the Payment Integrity team to ensure that all commitments are met, target budgets are achieved and resources are used effectively and efficiently. Organize, coordinate and ensure the team adheres to departmental standards, policies and procedures.
• Drives the development of best in class and forward thinking methods/criteria for identifying and correcting fraud and abuse issues. Integrates information from multiple sources, discerns implications for future analysis and identifies opportunities for enhancing integrity of medical data.
• Works in conjunction with external vendors to implement best in class programs that are needed within the organization.
• Coordinates with Compliance Department to satisfy governmental programs fraud, waste and abuse requirements (Medicare, FEHB and Medicaid).
• Partners with IT, Finance, Product Management and Market Intelligence, Claims, Client Services and areas within Health & Network Management to champion, develop, and monitor fraud and abuse initiatives for medical and/or network management programs.
• Prepares and delivers well-organized and compelling presentations to reflect key findings,    analytic methods to determine such findings, future analysis and implications; and the identifications of opportunities to drive business improvements.
• Create reporting that identifies trends and patterns of fraud and abuse through data analysis.
• Performs cost benefit analysis for key organizational programs and initiatives impacting medical cost and performance.
• Assures compliance with sound principles of economic assessment and uses explanatory and predictive models in the development, support and analysis, and determining the value of future medical management initiatives.
• Performs other related duties as assigned

Required Qualifications:

Experience Required:

• Certified coding credential (RHIT, RHIA, CPC, CPC-P, CPCH, CCS, CCS-P) preferred
• Minimum of three (3) years in a management role directing fraud and abuse programs or related activities for a manage care, health insurance, pharmaceutical or other health related organization required.
• Minimum of three (3) years of experience in leading staff in projects or supervisory/management position required.
• Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; predictive modeling and forecasting; key performance indicators as it relates to medical cost data.
• Demonstrated project management experience in running corporate wide projects
• Nature of the work requires progressive  interpersonal communication, decision making, financial and technical skills; ability to introduce new ideas, processes, measures and tools to improve healthcare performance
• High energy; strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
• Demonstrated ability to function in a creative, “out-of-the-box” thinking in order to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
• Knowledge of medical claims data and managed care membership data
• Knowledge of business intelligence applications, data, and tools
• Advanced technical skills which includes, but is not limited to,  MS Access and Excel skills
• Knowledge of Medicare and Medicaid Reimbursement methodologies a plus.

Preferred Qualifications: Education Qualifications:

• Bachelor’s Degree in Finance, Accounting, Statistics, Health-related Science or Computer Science. Masters degree preferred.

Compensation/Benefits:

Henry Ford Health System offers family health, dental, and retirement plan options.  More details will be provided during the interview process.

Instructions for Resume Submission:

To apply- please follow the attached link http://p.rfer.us/HENRYFORDuUu62f

Apply Online: http://p.rfer.us/HENRYFORDuUu62f

Health Alliance Plan

Introduction:

Health Alliance Plan (HAP)

Health Alliance Plan (HAP) is a nonprofit, regional health plan based in Detroit, Michigan and a subsidiary of the Henry Ford Health System. We are actively recruiting a Lead Auditor to join our team.  HAP provides health coverage to more than 670,000 members and to companies of all sizes. For more than 50 years, HAP has partnered with leading doctors and hospitals, employers and community organizations to improve the health and well-being of its members. HAP offers a product portfolio with six distinct product lines: Group Insured Commercial, Individual, Medicare, Medicaid, Self-Funded and Network Leasing. HAP delivers award-winning preventive services, disease management, wellness programs and personalized customer service. The National Committee for Quality Assurance has awarded HAP’s commercial HMO and HAP Senior Plus Excellent Accreditation.

Job Description:

GENERAL SUMMARY: 

Develop, implement and manage strategic fraud, waste, and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Responsible for planning, organizing, directing, implementing and leading department assignments. Deliver guidance and mentoring to team members. This position will provide senior level expertise in fraud, waste, and abuse analytics, and strategic decision making as it relates to compliance requirements and medical cost savings initiatives. Lead the team appropriately on investigations of all possible fraud, waste, and abuse referrals. Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis. Attend state and federal meetings as required by specific contracts. Prepare and distribute monthly, quarterly, and annual savings reports. Prepare and deliver presentations in a clear and concise manner to communicate findings from audits to management, provider groups, and other stakeholders. Consult with business unit leaders and employees regarding implementation of initiatives and support decision making.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Formulate plans to develop an ongoing process to identify opportunities for recovering erroneous or fraudulent claims.
• Possess and maintain in-depth knowledge of HAP business, products, programs (including claims reimbursement, benefits, provider and program data, networks etc.) and complex research principles/ methodologies.
• Identify, evaluate and implement other opportunities for cost savings (not necessarily related to claims payments) or revenue enhancements through operational audits or other means.
• Provide mentoring and guidance to team members. Ensures integrity and reporting accuracy of the department.
• Serve as a subject matter expert and consultant to HAP’s senior leadership. Develop solutions to complex issues and present recommendations to senior management as well as employees at various corporate levels.
• Develop, implement and maintain data mining activities and data analysis using available tools.
• Is the point of contact for all fraud, waste, and abuse vendors.
• Participate in meetings with Providers to explain audits and required corrective action.
• Act as liaison with other departments regarding Provider-related inquiries such as overpayments, settlements, and other financial issues arising from Payment Integrity activities.
• Act as a health care consultant by developing strategies and programs to reduce health care benefit costs and improve quality of care. Collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results.
• Perform other duties as assigned.

Required Qualifications:

• Must have a coding credential from AHIMA or AAPC (i.e., CCS, CCS-P, RHIA, RHIT, CPC, etc.)
• Minimum of five (5) 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 ability to integrate and co relate information from different domains and subject areas.
• At least three (3) years of experience in leading staff in projects or supervisory/management position preferred.
• Strong team player with high level of integrity.
• Flexible, self-driving, resourceful, highly focused and high attention to detail.

Preferred Qualifications: Education Qualifications:

• Bachelor’s degree in Business Administration, Economics, Health Care, Finance, Information Systems, Statistics or other related field

Compensation/Benefits:

Henry Ford Health System offers family health, dental, and retirement plan options.  More details will be provided during the interview process.

Instructions for Resume Submission:

To apply- please follow the attached link http://p.rfer.us/HENRYFORDYpC62a

Apply Online: http://p.rfer.us/HENRYFORDYpC62a

Health Information Associates

Job Description:

Headquartered in Pawleys Island, SC, Health Information Associates (HIA) is a privately held company and was founded in 1992 by Betsy Bailey, RHIA and Deane Beamer, MHA. Prior to 1992, Mrs. Bailey held Director of HIM positions at two (2) hospitals in Virginia. Mr. Beamer had over thirty (30) years of experience as an Administrator working in various hospitals throughout the southeast.

Since its inception, HIA has partnered with hundreds of hospitals nationwide to provide customized comprehensive coding compliance reviews and educational services as well as coding support. HIA has grown to become a highly respected provider due to its ability to adapt to industry changes while maintaining a cohesive and conservative approach. HIA’s attention to individual client needs, from the smallest critical access hospital to the largest healthcare corporation, has led to the type of long term and mutually beneficial partnerships it is fortunate to share with its clients.

Responsibilities:

• Codes all requested outpatient acute care facility records using the most accurate and appropriate ICD-10-CM/PCS, and
• CPT codes in accordance with coding guidelines.
• Abstracts, codes and assigns necessary demographic and clinical data elements required
• Uses 3M encoder to ensure appropriate reimbursement.
• Writes appropriate, non-leading queries.
• Maintains quality and productivity according to client requirements.
• Completes all I-10 education as required within established deadlines.
• Commits to continually improving his/her coding skills by actively participating in all education sessions.
• Reports to the Coding Services Manager.

Qualifications:

• RHIA, RHIT, and/or CCS
• Minimum 3 years outpatient coding experience in an acute care facility.
• I-10-CM/PCS training
• Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources.
• High Speed Internet via Cable (no Satellite or wireless cell based)
• Independent, focused individual able to work remotely.

Instructions for Resume Submission:

Apply Online: http://www.Click2Apply.net/p27cfzzx4v8jsdw2

PI98216857

Kalamazoo Psychiatric Hospital

 Introduction

This is a key position in the Health Information Department. Employees in this position perform a variety of functions designed to maintain the health information management system in accordance with hospital policies and procedures, DHHS rules and regulations, and accrediting and regulatory requirements. This position is primarily responsible for managing the release of patient information process, and functions as the back-up Assistant Freedom of Information Act (FOIA) Coordinator, as well as the back-up in the absence of the department director.

Job Description

Employees in this job perform a variety of activities designed to maintain medical record systems in state facilities. Work is performed through the application of a body of knowledge related to the methods, practices, procedures, policies, regulations and laws governing medical record creation and use.

There are three classifications in this job.

Medical Record Examiner 8
This is the entry level. The employee, in a learning capacity and under close supervision, performs a range of medical record examiner assignments.

Medical Record Examiner 9
This is the intermediate level. The employee works in a developing capacity with
increased responsibility for performing an expanding range of medical record examiner assignments.

Medical Record Examiner E10
This is the experienced level. The employee performs a full range of medical record examiner assignments and uses considerable independent judgement in making decisions requiring the interpretation and application of guidelines with considerable latitude to specific situations.

Required Qualifications

Knowledge, Skills, and Abilities

NOTE: Some knowledge in the area listed is required at the entry level,
developing knowledge is required at the intermediate level, and
considerable knowledge is required at the experienced level.

Knowledge of medical record keeping techniques and procedures.
Knowledge of accreditation body regulations and State and Federal statutes governing medical record creation and use.
Knowledge of medical record indexing, coding and abstracting methods.
Knowledge of reference materials used in the field of medical science.
Knowledge of medical terminology.
Knowledge of research methods.
Ability to design and maintain a medical record system.
Ability to interpret and apply policies, regulations and laws to the work area.
Ability to establish policies and procedures.
Ability to obtain and use confidential information discreetly and objectively.
Ability to develop procedural manuals and training materials.
Ability to communicate effectively.

Experience

Medical Record Examiner 8
No specific type or amount is required.

Medical Record Examiner 9
One year of experience equivalent to a Medical Record Examiner 8.

Medical Record Examiner E10
Two years of experience equivalent to a Medical Record Examiner, including one year equivalent to a Medical Record Examiner 9.

Special Requirements, Licenses, and Certifications
Certification by the American Health Information Management Association as a Registered Health Information Technician or Registered Health Information Administrator.

The Department of Corrections will not hire individuals who have been convicted of a felony or who have felony charges pending, in accordance with Public Act 140 of 1996.

NOTE: Equivalent combinations of education and experience that provide
the required knowledge, skills, and abilities will be evaluated on an
individual basis

Preferred Qualifications

Certification by the American Health Information Management Association as a
Registered Health Information Technician or Registered Health Information
Administrator.

Knowledge of medical record keeping techniques and procedures.
Knowledge of accreditation body regulations and State and Federal statutes governing
medical record creation and use.
Knowledge of medical record indexing, coding and abstracting methods.
Knowledge of reference materials used in the field of medical science.
Knowledge of medical terminology.
Knowledge of research methods.
Ability to design and maintain a medical record system.
Ability to interpret and apply policies, regulations and laws to the work area.
Ability to establish policies and procedures.
Ability to obtain and use confidential information discreetly and objectively.
Ability to develop procedural manuals and training materials.
Ability to communicate effectively.

Education Qualifications

Possession of an associate’s degree in health information or medical record
technology.

Compensation/Benefits

http://www.michigan.gov/mdcs/0,4614,7-147-22854_22857—,00.html

Apply Online: https://www.governmentjobs.com/careers/michigan/jobs/1635263/health-information-management-examiner?location%5B0%5D=kalamazoo&sort=PositionTitle%7CAscending&pagetype=jobOpportunitiesJobs

Kalamazoo Psychiatric Hospital

Introduction:

The Kalamazoo Psychiatric Hospital is operated by the State of Michigan. We provide inpatient treatment and services to adults with mental illness and/or developmental disabilities, as well as evaluation and treatment for individuals deemed incompetent to stand trial. We are currently seeking to hire a Health Information Management Director. Please note that this position is only open until August 21, 2017 at 11:59 PM.

Job Description:

The Health Information Management (HIM) Director is responsible to perform a variety of functions designed to maintain the health information management system at the Kalamazoo Psychiatric Hospital. The individual in this position is responsible for planning, organizing, and directing the services related to health information management, including but not limited to:

• Functioning as the hospital’s Privacy Officer and Assistant Freedom of Information Act (FOIA) Coordinator
• Providing guidance, supervision, and support to departmental employees (currently a department of 4 staff)
• Monitoring documentation compliance with MDHHS and hospital policies, federal and state laws/statutes, and standards from accrediting, funding, and regulatory organizations
• Managing the documentation process as it relates to patients deemed incompetent to stand trial
• Ensuring customer service standards are met with both internal and external stakeholders
• Implementing departmental performance improvement activities

Required Qualifications:

EXPERIENCE:

• Four years of experience equivalent to a Medical Record Examiner, including two years equivalent to a Medical Record Examiner E10 or one year equivalent to a Medical Record Examiner Supervisor 11; or
• Five years of administrative support, supervisor experience maintaining medical record systems, monitoring the quality of medical record keeping and responding to requests for medical record information.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Thorough knowledge of accrediting body regulations and state and federal statutes governing medical record creation and use.
• Thorough knowledge of medical records keeping, techniques and procedures, and medical records indexing, coding and abstracting methods.
• Knowledge of training and supervisory techniques.
• Ability to instruct, direct and evaluate employees.
• Ability to obtain and use confidential information discreetly and objectively.
• Ability to communicate oral and verbal technical information effectively.
• Ability to maintain records, prepare reports and compose correspondence related to the work.
• Ability to develop procedural manuals and training materials.

CERTIFICATES, LICENSES, REGISTRATIONS:

Certification by the American Health Information Management Association as a Registered Health Information Technician or Registered Health Information Administrator.

Preferred Qualifications:

Preferred experience in a hospital setting and/or working with a similar patient population.

Education Qualifications:

Possession of an associate’s degree in health information or medical record technology or a bachelor’s degree in medical records management/health information management.

Compensation/Benefits:

This is a full-time, benefits eligible position through the State of Michigan with an annual salary of $48,776.00 – 70,699.20. State employment benefits include everything from health insurance to retirement income and are worth about 40% of an employee’s salary.

Instructions for Resume Submission:

Applicants must include a cover letter and resume, or they may not be considered for the position. Please apply online no later than August 21, 2017 at 11:59 PM at:  https://www.governmentjobs.com/careers/michigan/jobs/1760059/health-information-management-director?location[0]=kalamazoo&sort=PositionTitle%7CAscending&pagetype=jobOpportunitiesJobs

 

Please note the Kalamazoo Psychiatric Hospital also has a Health Information Management Examiner position available, and applicants for that position can be submitted at: https://www.governmentjobs.com/careers/michigan/jobs/1635263/health-information-management-examiner?location[0]=kalamazoo&sort=PositionTitle%7CAscending&pagetype=jobOpportunitiesJobs