Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.

Primary Function/General Purpose of Position

Under the guidance of the Director, Compliance this position contributes to the Bon Secours Mercy Health mission and vision by serving as a senior auditor of provider revenue cycle compliance.  This position provides compliance program-related audit activities relative to Bon Secours Mercy Health operations conducted at local and remote locations and supports provider compliance education and Leadership requests. Conducts specialized compliance investigative audits for Leadership and as part of due diligence to ensure the accuracy and completeness of provider documentation and coding that results in appropriate reimbursement and data integrity and validation of coded information.  

Essential Job Functions

Conducts independent compliance investigative audits requested by Legal or Leadership and as part of the Compliance due diligence during merger and acquisition activity

Assists in the preparation of audit reports for presentation to Legal or Leadership and presents findings and proposed action plans

Performs investigative audits and assists with response and development of corrective action plans stemming from governmental reviews and inquiries

Performs annual compliance workplan provider revenue cycle audits and projects related to the European Group

Assists in the quality review of Bon Secours Mercy Health coding, billing, and claims processing to ensure compliance with policies

Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation

Demonstrates advanced industry and audit knowledge and is recognized as a subject matter resource for the team and the ministry

Performs research, creates presentations, and otherwise supports the Revenue Cycle Compliance team with developing written reports, educational materials, and trending dashboards

Utilizes data analytics and extraction for developing trends, metrics and dashboards related to external audit activity of governmental agencies, denials, or regulatory changes

Conducts and assists with routine provider revenue cycle monitoring initiatives established from data analytics

Acts as a Superuser for audit and compliance applications and platforms

Develops standard operating procedures (SOPs) and process workflows to ensure standardization across the ministry

Responsible for training new staff on audit processes, systems, coding guidelines (to include annual and periodic coding changes), and regulatory changes impacting revenue cycle

Provides guidance and serves as resource to auditing staff regarding SOPs, coding questions, audit findings, and audit report development

Ensures that Revenue Cycle Compliance leadership is apprised of local, remote and emerging issues, adverse outcomes or deficiencies that could impact Bon Secours Mercy Health's public status

Maintains awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking

Displays a commitment to excellence, accuracy, and thoroughness in all activities and searches for way to improve and promote quality

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) (required)

Certified Outpatient Coder (COC) (preferred)

Certified Professional Medical Auditor (CPMA) (preferred)

Certificate of Healthcare Compliance (CHC) (preferred)

Registered Health Information Tech (RHIT) (preferred)

Education

High School Diploma/GED (required)

Vocational and Technical Degree, Healthcare Auditing, Healthcare or Health Information Management (preferred)

Bachelor’s Degree, Healthcare Auditing, Healthcare or Health Information Management (preferred)

Work Experience

1 year experience within healthcare revenue cycle operations, healthcare auditing, Epic Electronic Medical Records System. (required)

1 year experience of demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies. (required)

1 year experience of extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations and compliance guidance. (required)

As a Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

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What we offer

\n \n Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)\n Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts\n Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders\n Tuition assistance, professional development and continuing education support\n \n

Benefits may vary based on the market and employment status.

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com