Strategic Healthcare Compliance Auditor & Educator

WVU Medicine; United States; On-site; USD 85,000 - 125,000; Full time

Job summary

SYSTEM West Virginia University Health System seeks an Enterprise Compliance Auditor/Educator to assist with policy development and monitoring to ensure adherence to federal and state regulations. The role involves independent data analysis, audits, and presenting findings to leadership.

Responsibilities include risk assessment, scope definition with senior leaders, and education across departments. Requires related healthcare revenue cycle experience and potential CHC certification.

Qualifications

• Five (5) years of progressive experience in a healthcare organization with extensive knowledge of hospital revenue cycle processes and related regulatory/payor guidelines.
• Bachelor’s Degree with two (2) years of progressive experience in healthcare revenue cycle and related guidelines.
• CHC Certification preferred to demonstrate knowledge of a Compliance Program.

Responsibilities

• Participates in annual and ongoing assessment of regulatory and administrative risk; contributes to the compliance work plan.
• Defines audit scope and objectives with senior compliance leadership.
• Develops data analytics reports to identify audit universe and selects samples.
• Communicates with executives, management, and front-line staff to close audit areas and document findings.
• Performs audits to ensure CMS, multi-state and payor compliance; coordinates audits across WVUHS and affiliates.
• Supports revenue integrity controls through charge capture analysis and coding/billing review; recommends corrective actions.
• Conducts regulatory research to understand federal and state regulations; applies to audits.
• Reviews medical record billing and related documentation.
• Prepares audit summaries for enterprise leadership and WVUHS board committees.

Skills

Organizational skills

Time management

Written communication

Presentation skills

EMR usage

Independent worker

Education

High School diploma or equivalent

Bachelor’s Degree

CHC certificate (HCCA)

Tools

EMR systems

Billing systems

Job description

SYSTEM West Virginia University Health System seeks an Enterprise Compliance Auditor/Educator to assist with policy development and monitoring to ensure adherence to federal and state regulations. The role involves independent data analysis, audits, and presenting findings to leadership.

Responsibilities include risk assessment, scope definition with senior leaders, and education across departments. Requires related healthcare revenue cycle experience and potential CHC certification.