Revenue Compliance Auditor

Rhode Island Hospital; Providence (RI); On-site; USD 70,000 - 110,000; Full time

Job summary

Brown University Health is seeking a Revenue Compliance Auditor to perform retrospective audits of LifeChart/EPIC documentation, assess billing and coding accuracy, and ensure adherence to federal and state regulations. The role includes developing audit plans, writing reports, and guiding junior staff within the Compliance program.

Under supervision, you will provide compliance training to employees and physician staff, monitor payer requirements (Medicare/Medicaid/Tricare), and support

Qualifications

• Bachelor's degree in health science preferred.
• CPC and/or CCS-P certifications required; CPC-A consideration.
• Experience with EPIC is preferred; knowledge of coding and reimbursement policies.
• Strong analytical and communication skills; project management abilities.

Responsibilities

• Conduct retrospective audits of documentation, care delivery, coding and billing.
• Develop audit plans, guidelines, tools and scope with leadership.
• Prepare reports of factual audit findings with actionable recommendations.
• Provide training and guidance to Compliance staff and clinicians.
• Investigate issues arising from complaints or investigations as needed.

Skills

CPC

CCS-P

CPC-A

Analytical thinking

Communication

Education

Bachelor's degree in health science

CPC / CCS-P certifications

Tools

EPIC

MS Word

MS Excel

MS Outlook

Copilot

Job description

SUMMARY

The Revenue Compliance Auditor reports to the Manager, Revenue Compliance and Provider Education. Under general supervision, assists in executing various portions of the Brown University Health Corporate Compliance Plan.

Develops and provides compliance training to employees' and physician staff. Conducts retrospective audits of LifeChart/EPIC documentation to assess billing, coding, patient care and compliance with Brown University Health general and specific policies and federal and state regulations. Auditors may participate in compliance investigations in those areas of risk identified by federal and state regulators. Provides a written summary of work, where problems are found and makes recommendations to correct. Provides functional guidance and direction to less experienced revenue compliance audit staff.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible, and high-value services within the environment of a comprehensive integrated academic health system. Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.

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 Manager, Revenue Compliance and Provider Education develops audit plans, guidelines, tools, and determines audit scope and methods. Reviews documents, makes inquiries, documents audit work performed and confirms application of procedures to afford a reasonable basis for objective opinions. Drafts reports of factual audit findings and recommendations designed to improve compliance with federal and state regulations. Approves final, reports, and recommendations along with the Vice President of Corporate Compliance and Internal Audit, providing guidance and support as needed.

Regularly monitoring changes to various third-party standards, particularly federal payers (e.g., Medicare, Medicaid, Tricare), contributes to the development of internal procedures addressing those changes. Evaluate operational compliance with established procedures across affiliate departments or units to support 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 Corporate Compliance Plan designed to measure the risk of non-compliance, demonstrates the effectiveness of the Program to enhance the level of system-wide compliance.

May assist Vice President, Corporate Compliance/Internal Audit and the Manager, Revenue Compliance and Provider Education by performing investigations arising from complaints received via the Compliance Response Line and because of federal or state investigations.

Develops and provides compliance education to Brown University Health clinical employees who bill for professional services on general or specific issues, when needed. Participates in councils, quality improvement teams, and other such committees as required. Performs other related duties, as necessary.

BASIC KNOWLEDGE

Bachelor's degree in health science profession is preferred; CPC and /or CCS-P certifications required. Consideration will be given for CPC-A

EXPERIENCE

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. . Understanding the structure and objectives of a healthcare compliance program is preferred.

General knowledge of third-party coding and reimbursement policies understanding to compare details of diagnosis, prescription, treatment, and evaluation of documentation necessary to obtain appropriate reimbursement for patient care services. Knowledge of ICD-10-CM, HCPCS, and APC Coding methodologies, as well as Medicare/Medicaid regulatory guidance is required.

Experience working with EPIC is preferred. skills, critical thinking skills and project management skills are necessary. Ability to balance Consideration will be given for given for experience with other electronic health record systems. Strong analytical, organizational and communication skills are required. Computer skills required are MS Word, Excel, MS Outlook, and Copilot (A