Children's Wisconsin
Senior Revenue Compliance Auditor- Remote
Children's Wisconsin, Milwaukee, Wisconsin, United States, 53244
Senior Revenue Compliance Auditor - Remote
Location: Remote Children's Wisconsin has an opportunity for a Senior Revenue Compliance Auditor on our team. This role requires five plus years of experience in healthcare industry revenue cycle, billing, denials, and coding, with thorough understanding of hospital and physician coding and billing practices, and Medicaid and Medicare. What you will do: Researching, analyzing, monitoring and auditing charging and billing processes, quality of documentation to support billing, and coding and billing practices for professional and technical services to ensure compliance with applicable policies and procedures and healthcare billing regulations. Identify and facilitate implementation of best practices, process improvements, internal controls, and corrective actions when appropriate. Collaborate with Revenue Cycle, Financial Services, Health Information Management and clinical areas as needed; actively participate on teams formed to examine applicable elements of the Revenue Cycle. ESSENTIAL FUNCTIONS: Exhibits guiding behaviors that reflect Children’s values and support our mission and vision. Performs reviews and investigations of regulatory requirements and guidelines, and internal controls or processes to ensure compliance for documentation, charging, coding, reimbursement, and billing. Monitors developments and changes in federal and state regulation, policy, guidelines, industry best practices, and technological advancements related to charge capture, documentation, billing, coding, and reimbursement; communicates this information to all applicable parties in a timely manner for appropriate follow-up actions. Collaborates with all clinical and operational departments involved in coding, billing, and reimbursement activities to improve charging, coding and billing compliance and effectiveness. Serves as an institutional subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, and payer requirements and policies. Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third-party payer billing rules, and OIG compliance standards. Participates on teams assembled to respond to government and commercial audits of claims; facilitates submission of records and resolution as needed and maintains documentation. Identifies risks related to compliance with billing regulations and revenue capture, including risk evaluation of proposed or actual changes in operational or clinical documentation, coding, or billing practices. Participates in annual enterprise risk assessments of potential and detected charging, coding and billing compliance deficiencies. Oversees data analysis used to identify trends, issues, and risk areas related to coding and billing compliance, and conducts compliance auditing/monitoring activities. Meets as needed with the nursing areas and other clinical departments to discuss issues identified during ongoing monitoring/auditing. Helps develop corrective action plans and works with applicable areas to ensure action plans can be implemented effectively. Serves as a member of cross-functional teams to provide technical expertise related to coding and billing compliance for all patient charges. Presents results of audits and special projects to management. Performs other duties or special investigations as assigned. MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED: Bachelor’s degree required. Healthcare industry revenue cycle, billing, denials, and coding background with a minimum of five years’ experience. Professional certification preferred (Certificate in Healthcare Compliance, Certified Professional Coder, Certified Coding Specialist, Certified Internal Auditor, or equivalent). Understanding of hospital and physician coding and billing practices required, as well as payer guidelines including Medicaid and Medicare. Demonstrated knowledge of correct coding principles (CCI/OCE edits) of CPT, ICD10, HCPCS and modifier selections, as well as revenue codes. Thorough knowledge of clinical documentation requirements, ICD-10, and DRG assignment and the impact of these requirements on the revenue cycle and operations. Knowledge of Epic systems and coding software. Ability to collect, analyze, and evaluate information pertaining to revenue cycle compliance. Excellent oral and written communication skills to communicate effectively with all levels of management, staff and outside individuals to ensure risk mitigation strategies are appropriate and effective. Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law. Certifications/Licenses:
CCS-Certified Coding Specialist - American Health Information Management Association, CHC-Certified in Healthcare Compliance - Compliance Certification Board, CIA-Certified Internal Auditor - ISACA, CPC-Certified Professional Coder - American Board of Professional Coders Seniority level
Mid-Senior level Employment type
Full-time Job function
Finance and Sales Industries
Hospitals and Health Care
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Location: Remote Children's Wisconsin has an opportunity for a Senior Revenue Compliance Auditor on our team. This role requires five plus years of experience in healthcare industry revenue cycle, billing, denials, and coding, with thorough understanding of hospital and physician coding and billing practices, and Medicaid and Medicare. What you will do: Researching, analyzing, monitoring and auditing charging and billing processes, quality of documentation to support billing, and coding and billing practices for professional and technical services to ensure compliance with applicable policies and procedures and healthcare billing regulations. Identify and facilitate implementation of best practices, process improvements, internal controls, and corrective actions when appropriate. Collaborate with Revenue Cycle, Financial Services, Health Information Management and clinical areas as needed; actively participate on teams formed to examine applicable elements of the Revenue Cycle. ESSENTIAL FUNCTIONS: Exhibits guiding behaviors that reflect Children’s values and support our mission and vision. Performs reviews and investigations of regulatory requirements and guidelines, and internal controls or processes to ensure compliance for documentation, charging, coding, reimbursement, and billing. Monitors developments and changes in federal and state regulation, policy, guidelines, industry best practices, and technological advancements related to charge capture, documentation, billing, coding, and reimbursement; communicates this information to all applicable parties in a timely manner for appropriate follow-up actions. Collaborates with all clinical and operational departments involved in coding, billing, and reimbursement activities to improve charging, coding and billing compliance and effectiveness. Serves as an institutional subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, and payer requirements and policies. Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third-party payer billing rules, and OIG compliance standards. Participates on teams assembled to respond to government and commercial audits of claims; facilitates submission of records and resolution as needed and maintains documentation. Identifies risks related to compliance with billing regulations and revenue capture, including risk evaluation of proposed or actual changes in operational or clinical documentation, coding, or billing practices. Participates in annual enterprise risk assessments of potential and detected charging, coding and billing compliance deficiencies. Oversees data analysis used to identify trends, issues, and risk areas related to coding and billing compliance, and conducts compliance auditing/monitoring activities. Meets as needed with the nursing areas and other clinical departments to discuss issues identified during ongoing monitoring/auditing. Helps develop corrective action plans and works with applicable areas to ensure action plans can be implemented effectively. Serves as a member of cross-functional teams to provide technical expertise related to coding and billing compliance for all patient charges. Presents results of audits and special projects to management. Performs other duties or special investigations as assigned. MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED: Bachelor’s degree required. Healthcare industry revenue cycle, billing, denials, and coding background with a minimum of five years’ experience. Professional certification preferred (Certificate in Healthcare Compliance, Certified Professional Coder, Certified Coding Specialist, Certified Internal Auditor, or equivalent). Understanding of hospital and physician coding and billing practices required, as well as payer guidelines including Medicaid and Medicare. Demonstrated knowledge of correct coding principles (CCI/OCE edits) of CPT, ICD10, HCPCS and modifier selections, as well as revenue codes. Thorough knowledge of clinical documentation requirements, ICD-10, and DRG assignment and the impact of these requirements on the revenue cycle and operations. Knowledge of Epic systems and coding software. Ability to collect, analyze, and evaluate information pertaining to revenue cycle compliance. Excellent oral and written communication skills to communicate effectively with all levels of management, staff and outside individuals to ensure risk mitigation strategies are appropriate and effective. Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law. Certifications/Licenses:
CCS-Certified Coding Specialist - American Health Information Management Association, CHC-Certified in Healthcare Compliance - Compliance Certification Board, CIA-Certified Internal Auditor - ISACA, CPC-Certified Professional Coder - American Board of Professional Coders Seniority level
Mid-Senior level Employment type
Full-time Job function
Finance and Sales Industries
Hospitals and Health Care
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