Revenue Compliance Auditor

Responsibilities

• Independently organizes and conducts retrospective audits of documentation, care delivery, coding and billing to ensure compliance with Brown University Health policies and federal and state rules, primarily Medicare and Medicaid regulations.
• In consultation with the Director, Revenue Compliance and Education, develops audit plans, guidelines, tools, and determines audit scope and methods.
• Creates audit work papers. Inspects documents, makes inquiries and confirms application of procedures in order to afford a reasonable basis for objective opinions.
• Drafts written reports of factual findings and recommendations designed to improve compliance. Reviews final, approved reports and recommendations with affiliate management, providing advice and counsel to same as needed.
• Routinely acquires information on changes to various third-party standards, particularly federal payers (e.g., Medicare, Medicaid, Tricare), participates in development of internal procedures to respond to same.
• Affirms operational compliance to procedures in various affiliate departments or units in order to maximize accuracy and completeness of charges and codes submitted for payment.
• Modifies methods, approach and tests based upon the type of organization reviewing and unique compliance issues; for example, research, coding or physician documentation issues.
• Assists in the orientation of new Compliance staff, providing ongoing review of work to ensure accuracy and consistency of methodologies, and serving as a functional resource.
• Executes various portions of the Brown University Health Compliance Plan designed to measure the risk of non-compliance, demonstrates the effectiveness of the Program to enhance the level of system-wide compliance.
• Assists the Vice President, Corporate Compliance and the Director, Revenue Compliance and Education by performing investigations arising from complaints received via the Compliance Response Line and as a result of federal or state investigations.
• Develops and provides compliance education to Brown University Health employees on general or specific issues, when needed.
• Participates in councils, quality improvement teams, and other such committees as required.

Qualifications

• Bachelor’s degree in health science profession is preferred
• CPC, CCS-P certifications required and Epic experience
• Consideration will be given for CPC-A
• Three years recent, professional-level health care organization experience
• A minimum of one to two years of audit/compliance experience is desirable, preferably with a healthcare organization or third-party payer
• One-year on-the-job experience in order to gain specific knowledge of federal and state regulatory issues relating to healthcare, and to become familiar with the full range of auditing activities
• In-depth understanding of the structure and objectives of a healthcare compliance program
• General knowledge of third-party reimbursement policies sufficient to compare details of diagnosis, prescription, treatment and evaluation of documentation necessary to obtain appropriate reimbursement for patient care services
• Knowledge of HCPCS and APC Coding methodologies, as well as Medicare/Medicaid regulatory guidance
• Detailed knowledge of healthcare information systems, audit software, database structure and of reimbursement schemes and pertinent regulatory requirements is strongly desired
• Strong analytical, organizational and communication skills are required
• Computer skills required are MS Word, Excel, MS Outlook and general database experience; knowledge of personal computer software applications that interface with various billing databases is desirable
• Demonstrated written and oral communication skills, planning skills, problem solving skills and project management skills
• Ability to balance remote and in office work