Healthcare Compliance Auditor – Enterprise Risk

Description: • Works collaboratively with the Compliance Manager on creating auditing protocols • Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies • Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas • Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports • Utilizes data analytics techniques, statistical analysis and modeling to detect and trend potential claims and billing compliance issues • Assists in auditing and investigations requested by the System Director, Compliance • Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes • Develops educational content on documentation, coding, and trending of non-compliant activities Requirements: • CCS, CPC, RHIT, or RHIA required • Auditing Experience, Experience with EPIC Electronic Medical Records System preferred • Two to four years of in-depth experience within healthcare operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager required • Demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies, as well as 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. • Excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations 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 Apply tot his job Apply To this Job