Adventist Health
Sr. Revenue Cycle Compliance Auditor
Adventist Health, Roseville, California, United States, 95678
Sr. Revenue Cycle Compliance Auditor
at Adventist Health Location: Sacramento, CA (Corporate Headquarters in Roseville)
Job Summary Works independently performing program, compliance, and risk‑based reviews of health‑care related activities to ensure accuracy of medical record documentation, coding, billing and policies. Provides written audit summaries with findings, recommendations, and action plans, and conducts revenue‑cycle investigations to mitigate risk.
Key Responsibilities
Perform comprehensive reviews of health‑care records for revenue‑cycle billing compliance, including medical necessity, compliance risk, denials, charge trends, and coding guidelines (CPT, HCPCS, ICD‑10‑CM, ICD‑10‑PCS).
Coordinate internal and external audits (RAC, Livanta, Target Probe, Educate, Attorney Client Privilege Audits) and produce audit findings, quantified impact, and improvement recommendations.
Disseminate audit findings and generate timely appeals, ensuring all deadlines are met.
Communicate audit findings and documentation requirements clearly through verbal and written reporting.
Lead multidisciplinary workgroups, serve as project lead, and mentor staff through on‑job training.
Support departmental initiatives, process improvement projects, and enhancement of audit methodologies and tools.
Participate in annual risk assessment and work‑plan development.
Perform other job‑related duties as assigned.
Requirements
Associate’s/Technical Degree or equivalent education/experience (required).
Bachelor’s Degree (preferred).
Five years’ experience in healthcare coding (inpatient, outpatient, rural health, or professional fee services) (required).
Five years’ experience in auditing clinic/facility revenue cycle (preferred).
Licenses / Certifications
Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS‑Phy), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) (required).
Professional Medical Auditor (CPMA), Certified E/M Coder (CEMC), Certified E/M Auditor (CEMA), Certified Documentation Integrity Practitioner (CDIP), Certified Clinical Documentation Specialist (CCDS), CIRCC‑AAPC, or Radiation Oncology Certified Coder (ROCC) (preferred).
Organizational Requirements Adventist Health requires all associates to receive the required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E‑Verify. By applying, you acknowledge having read the E‑Verify Participation and Right to Work notices.
About Adventist Health Adventist Health is a faith‑based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our team of more than 38,000 employees, physicians, medical staff, and volunteers is driven by the mission: living God’s love by inspiring health, wholeness, and hope.
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at Adventist Health Location: Sacramento, CA (Corporate Headquarters in Roseville)
Job Summary Works independently performing program, compliance, and risk‑based reviews of health‑care related activities to ensure accuracy of medical record documentation, coding, billing and policies. Provides written audit summaries with findings, recommendations, and action plans, and conducts revenue‑cycle investigations to mitigate risk.
Key Responsibilities
Perform comprehensive reviews of health‑care records for revenue‑cycle billing compliance, including medical necessity, compliance risk, denials, charge trends, and coding guidelines (CPT, HCPCS, ICD‑10‑CM, ICD‑10‑PCS).
Coordinate internal and external audits (RAC, Livanta, Target Probe, Educate, Attorney Client Privilege Audits) and produce audit findings, quantified impact, and improvement recommendations.
Disseminate audit findings and generate timely appeals, ensuring all deadlines are met.
Communicate audit findings and documentation requirements clearly through verbal and written reporting.
Lead multidisciplinary workgroups, serve as project lead, and mentor staff through on‑job training.
Support departmental initiatives, process improvement projects, and enhancement of audit methodologies and tools.
Participate in annual risk assessment and work‑plan development.
Perform other job‑related duties as assigned.
Requirements
Associate’s/Technical Degree or equivalent education/experience (required).
Bachelor’s Degree (preferred).
Five years’ experience in healthcare coding (inpatient, outpatient, rural health, or professional fee services) (required).
Five years’ experience in auditing clinic/facility revenue cycle (preferred).
Licenses / Certifications
Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS‑Phy), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) (required).
Professional Medical Auditor (CPMA), Certified E/M Coder (CEMC), Certified E/M Auditor (CEMA), Certified Documentation Integrity Practitioner (CDIP), Certified Clinical Documentation Specialist (CCDS), CIRCC‑AAPC, or Radiation Oncology Certified Coder (ROCC) (preferred).
Organizational Requirements Adventist Health requires all associates to receive the required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E‑Verify. By applying, you acknowledge having read the E‑Verify Participation and Right to Work notices.
About Adventist Health Adventist Health is a faith‑based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our team of more than 38,000 employees, physicians, medical staff, and volunteers is driven by the mission: living God’s love by inspiring health, wholeness, and hope.
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