Audit Compliance Specialist

Audit Compliance Specialist

BJC HealthCare has an opportunity for an Audit Compliance Specialist. This role is responsible for managing pay audit requests from managed care organizations, Medicare, Medicaid, and VA to ensure accurate payments and identify potential overpayments.

Ideal candidates will have some coding knowledge or revenue cycle/billing background to analyze payment details and procedure types, distinguishing between valid and invalid charges. Remote position, must reside in the Greater St. Louis or Kansas City areas.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC's patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children's Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

Preferred Qualifications

Role Purpose: Perform insurance billing and process audits and assists with special projects. Serve as a regulatory consultant and resource to management and departments at all levels and assist in developing appropriate action plans. Requires a high degree of analytical skills, the ability to work independently, the ability to maintain confidentiality and to be a catalyst for change.

Responsibilities:

• Performs detailed compliance, process and insurance billing audits in the hospital and outpatient facilities.
• Prepares audit work papers to document billing exceptions or patient care documentation issues.
• Identifies problems or critical issues in billing and patient care documentation.
• Assists with the identification of problems, analysis of problems and development of solutions.
• Assists in the preparation of formal written reports which detail audit findings and recommendations.

Minimum Requirements:

• Education: Associate's Degree
• Experience: 2-5 years
• Supervisor Experience: No Experience

Preferred Requirements:

• Licenses & Certifications: RN, CCS, RHIA, or RHIT

Benefits and Legal Statement

BJC Total Rewards

At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer