Compliance Auditor -Remote

About the role

The Revenue Cycle Compliance Hospital Auditor conducts audits to evaluate compliance with a wide variety of Federal and State laws, regulatory rules & regulations, PSJH policies and procedures. Areas of audit focus for this position may involve clinical and non-clinical services, including but not limited to revenue cycle: Rev Cycle departments, Rev Cycle Billing Offices, External Vendor; HIM Coding, Revenue Integrity RI, Chargemaster CDM, EPIC, and Clinical Documentation CDT.

Responsibilities

• Works collaboratively with Case Management, Utilization Review, Revenue Integrity, our PB Professional Revenue Cycle Compliance Team, Clinical Risk, Internal Legal Affairs and Finance under the supervision of the Rev Cycle Compliance Senior Manager.
• Navigates and analyzes data across both the Clinical EMR and Epic Billing systems.
• Reviews line-item charges, Revenue Codes, CPT descriptions, status, orders, supporting documentation, and reimbursement etc.
• Applies strong critical thinking and analytical skills to evaluate accuracy, identify discrepancies, and ensure compliance while completing focused audits.
• Audit findings are presented in a collaborative manner (verbally and visually) looking to a common goal of reducing risk within Providence as a system.
• Overpayments received in error are refunded following the CMS Voluntary Self Disclosure 60 Day Overpayment Rule.

Requirements

• Bachelor's Degree in Business, Healthcare, Finance, or similar field, Or 5 years of recent Hospital Billing auditing, Nurse Auditing, or Hospital billing and coding experience.
• 5 years of recent Hospital billing auditing or Hospital coding experience.

Qualifications

• Coding Certification from American Health Information Management Association.

Skills

• Strong critical thinking and analytical skills.

Benefits

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.

Pay

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Schedule

This position works remotely.