Revenue Compliance Auditor

William Backus Hospital Hartford , CT 06183

Posted 3 weeks ago

Work where every moment matters.

Every day, almost 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The story of Hartford HealthCare is the story of transformation - from a handful of disconnected organizations a decade ago to a unified system with a shared, value-based culture of accountability and innovation. The healthcare landscape has become highly competitive, with new players and disruptive technology and we are working to expand and create our system's organizational, leadership, cultural, and talent capabilities to ensure Hartford HealthCare will always be the first choice of the people we serve

The Revenue Compliance Auditor is responsible for executing clinical documentation, coding and billing audits as assigned or scheduled. The Revenue Compliance Auditor performs independent reviews to assess compliance with federal, state and private payor regulations, guidelines and requirements. Documentation and coding audits may include professional, facility (inpatient and outpatient), home health and skilled nursing facilities. Responsibilities include but are not limited to the following:

  • Conducts audits in accordance with the approved Revenue Compliance Work Plan or as requested by the Senior Auditor, Manager or Director. Maintains organized files to support audit observations and drafts related audit reports in accordance with agreed upon standards in a timely manner.

  • Collaborates with business owner to develop agreed-upon action plans to address findings identified during an audit. Communicates audit results and corrective action plans to audit stakeholders. Monitors progress of corrective actions and provides status reports to leadership. Independently validates that corrective action plans are implemented as intended.

  • Stays up to date on documentation, coding and billing regulations and requirements via professional organizations and through independent research and education on payor rules, requirements and regulatory guidelines (HHS/OIG, Medicare, Medicaid, NGS, Commercial Insurers, etc).

  • Assists with review and/or investigation of ComplianceLine reports as requested by the Director.

  • Assists with the development and revision of HHC and Department Policies and Procedures.

  • Participates in the annual and ongoing risk assessments to develop and revise the Revenue Compliance Work Plan.

  • Represents the department by participating in/on appropriate workgroups and committees providing compliance and audit guidance and insight.

Education:

Bachelor's Degree required. Master's Degree strongly preferred.

Experience:

  • Minimum of two years related work experience required - preferably in a hospital/healthcare system setting.

  • Minimum of two years work experience with CPT, HCPCS, and ICD-10 coding conventions required.

  • High degree of integrity, trust and confidentiality required.

  • Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary.

  • Knowledge of health care compliance programs and guidance, healthcare reimbursement and third party payor guidelines.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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Revenue Compliance Auditor

William Backus Hospital