Revenue Compliance Auditor

Summary The Revenue Compliance Auditor reports to the Director, Revenue Compliance and Education. Under general supervision, assists in executing various portions of the Brown University Health Compliance Plan. Develops and provides compliance training to employee and physician staff. Conducts retrospective audits of LifeChart documentation to assess billing, coding, patient care and compliance with Brown University Health general and specific policies and federal and state regulations. 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 makes recommendations to correct. Provides functional guidance and direction to less experienced clinical compliance audit staff. Responsibilities Consistently apply corporate values of respect, honesty and fairness while improving the health status of the region. Know and act in accordance with the Brown University Health Corporate Compliance Program and Code of Conduct. Organize and conduct 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. Develop audit plans, guidelines, tools and determine audit scope and methods in consultation with the Director. Create audit work papers, inspect documents, make inquiries, confirm application of procedures, and draft written reports of findings and recommendations. Review final approved reports and recommendations with affiliate management, advising as needed. Acquire information on changes to third‑party standards, especially federal payers, and develop internal procedures to respond. Asses operational compliance in various affiliate departments to maximize accuracy of charges and codes. Modify methods, approach and tests based on the organization’s type and compliance issues. Assist in orienting new compliance staff and serve as a functional resource. Execute portions of the Health Compliance Plan to measure risk of non‑compliance and demonstrate program effectiveness. Assist investigations from complaint lines and federal/state investigations. Provide compliance education to employees when needed. Participate in councils, quality improvement teams and other committees as required. Perform other related duties as necessary. Minimum Qualifications Bachelor’s degree in health science profession preferred; CPC, CCS‑P certifications required and Epic experience (CPC‑A considered). Three years recent, professional‑level health care organization experience. One to two years of audit/compliance experience desirable; one year on‑the‑job experience to gain knowledge of federal and state regulatory issues and auditing activities. In‑depth understanding of the structure and objectives of a healthcare compliance program. General knowledge of third‑party reimbursement policies to compare diagnosis, prescription, treatment and evaluation documentation for appropriate reimbursement. Knowledge of HCPCS and APC coding methodologies, Medicare/Medicaid regulatory guidance. Detailed knowledge of healthcare information systems, audit software, database structure and reimbursement schemes, and regulatory requirements. Strong analytical, organizational and communication skills; computer skills in MS Word, Excel, Outlook and database applications. Demonstrated written and oral communication, planning, problem‑solving and project management skills. Ability to balance remote and in‑office work. Work Environment Normal office environment. Independent Action Perform independently within Brown University Health's administrative policies and procedures, referring unusual problems to the Manager, Revenue Compliance and Conflict of Interest. Supervisory Responsibility None Pay Range: $71,136.00 – $117,353.60 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location Corporate Headquarters – 15 LaSalle Square, Providence, Rhode Island 02903 Work Type Monday to Friday, 8:00 am – 4:30 pm (Day Shift) Daily Hours 8 hours Driving Required No #J-18808-Ljbffr