Senior Compliance Auditor

Role Overview

• Conducts independent compliance investigative audits requested by Legal or Leadership and as part of the Compliance due diligence during merger and acquisition activity
• Assists in the preparation of audit reports for presentation to Legal or Leadership and presents findings and proposed action plans
• Performs investigative audits and assists with response and development of corrective action plans stemming from governmental reviews and inquiries
• Performs annual compliance workplan provider revenue cycle audits and projects related to the European Group
• Assists in the quality review of Bon Secours Mercy Health coding, billing, and claims processing to ensure compliance with policies
• Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation
• Demonstrates advanced industry and audit knowledge and is recognized as a subject matter resource for the team and the ministry
• Performs research, creates presentations, and otherwise supports the Revenue Cycle Compliance team with developing written reports, educational materials, and trending dashboards
• Utilizes data analytics and extraction for developing trends, metrics and dashboards related to external audit activity of governmental agencies, denials, or regulatory changes
• Conducts and assists with routine provider revenue cycle monitoring initiatives established from data analytics
• Acts as a Superuser for audit and compliance applications and platforms
• Develops standard operating procedures (SOPs) and process workflows to ensure standardization across the ministry
• Responsible for training new staff on audit processes, systems, coding guidelines (to include annual and periodic coding changes), and regulatory changes impacting revenue cycle
• Provides guidance and serves as resource to auditing staff regarding SOPs, coding questions, audit findings, and audit report development
• Ensures that Revenue Cycle Compliance leadership is apprised of local, remote and emerging issues, adverse outcomes or deficiencies that could impact Bon Secours Mercy Health's public status
• Maintains awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
• Displays a commitment to excellence, accuracy, and thoroughness in all activities and searches for way to improve and promote quality

Requirements

• 1 year experience within healthcare revenue cycle operations, healthcare auditing, Epic Electronic Medical Records System. (required)
• 1 year experience of demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies. (required)
• 1 year experience of extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations and compliance guidance. (required)
• Certified Professional Coder (CPC)
• American Academy of Professional Coders (AAPC) (required)
• Certified Outpatient Coder (COC) (preferred)
• Certified Professional Medical Auditor (CPMA) (preferred)
• Certificate of Healthcare Compliance (CHC) (preferred)
• Registered Health Information Tech (RHIT) (preferred)
• High School Diploma/GED (required)
• Vocational and Technical Degree, Healthcare Auditing, Healthcare or Health Information Management (preferred)
• Bachelor’s Degree, Healthcare Auditing, Healthcare or Health Information Management (preferred)

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
• Paid time off, parental and FMLA leave, short
• and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support