Audit Compliance Specialist

Overview

BJC HealthCare is a large nonprofit health care organization serving residents in the greater St. Louis, southern Illinois, and southeast Missouri regions. With over 30,000 employees and net revenues of $6.3 billion, BJC operates 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health, and wellness, workplace health, home health, community mental health, rehabilitation, long-term care, and hospice. BJC is the largest provider of charity care and community benefits in Missouri, with $785.9 million in community benefit annually.

Role Purpose

This role manages pay audit requests from managed care organizations, Medicare, Medicaid, and VA to ensure accurate payments and identify potential overpayments. The ideal candidate should have some coding knowledge or a background in revenue cycle/billing to analyze payment details and distinguish between valid and invalid charges.

Responsibilities

• Performs detailed compliance, process, and insurance billing audits in hospital and outpatient facilities.
• Prepares audit work papers to document billing exceptions or patient care documentation issues.
• Identifies problems or critical issues in billing and patient care documentation.
• Assists with the identification of problems, analysis of problems, and development of solutions.
• Assists in the preparation of formal written reports detailing audit findings and recommendations.

Minimum Requirements

• Associate's Degree
• 2-5 years of relevant experience
• No supervisory experience required

Preferred Requirements

• Licenses or certifications such as RNCCS, RHIA, or RHIT are preferred

Benefits and Legal Statement

Benefits: Comprehensive medical, dental, vision, life insurance, disability insurance, and legal services available first day of the month after hire date. BJC also offers a 4% automatic retirement contribution, 401(k) plan with a match, tuition assistance, adoption assistance, and various flexible spending accounts.

Paid Time Off: Combines vacation, sick days, holidays, and personal time.

Tuition Assistance: Available on the first day of employment.

Health Care and Dependent Care Flexible Spending Accounts:

Legal Statement: BJC is an equal opportunity employer and does not discriminate against applicants based on race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation.