Job Description:

Job Title: Compliance Audit Specialist
Location: Springfield, MO
Department: Compliance and Integrity
Employment Type: Full-time
Shift: Monday - Friday 8:00 A.M. - 5:00 P.M.

Job Summary:

The Compliance Audit Specialist supports the Compliance Office in its role of conducting comprehensive reviews of medical records and documents supporting claims for medical and behavioral health care services. Conducts specific audits to evaluate completeness of medical record documentation to support billing of services under the Federal health care program.

The Compliance Audit Specialist position offers…

All-Inclusive Employee Benefits Package - A robust full-time employee benefits package encompassing health, dental, vision, retirement, disability, life insurance, wellness program, and moreTelemedicine – 24/7 phone, web, or mobile app medical, behavioral health, & dermatology visitsEmployee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no costPaid Time Off - 29 days per year including vacation & holiday payWorkplace Culture** - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting healthy, joyful workforce engagement

Key Responsibilities:

Complete assigned audit work in accordance with Compliance Work PlanObjectively and independently review medical record documentation to determine if reimbursement is supported. Reviews include adequate documentation, medical necessity, diagnosis and procedure codes, proper payor responsibility and supplemental documentation within the medical record (e.g. treatment plans, assessments).Identification and reporting of abnormal billing patterns and other indicators (e.g. services not rendered, up-coding, unbundling, etc.) of suspected fraud and abuse to the Lead Compliance Audit Coordinator.Assist in audits related to Compliance investigations for potential overpayments.Presents findings and recommendations regarding the appropriateness of diagnosis and procedure codes in a professional and knowledgeable manner.Demonstrates problem solving strategies and recommends corrective action for deficiencies, including assisting with developing recommendations for changes in policies and procedures relevant to compliant coding and billing.Assist with developing recommendations for changes in policies and procedures relevant to compliant coding and billing.Other duties as assigned.

Knowledge, Skills, and Abilities:

Knowledge of Federal and state healthcare reimbursement requirementsProficient in ICD-10, CPT and HCPCS coding guidelinesAbility to prioritize work to meet deadlines consistently in a predetermined schedule.Ability and willingness to research and analyze data, draw conclusions, read, interpret and apply policies, procedures, laws and regulations.Strong analytical, written and verbal communications skills.Organizational skills, self-motivation, and the ability to work independently.Ability to use spreadsheets for tracking and reporting audit trends.Ability to work confidentially in a fast-paced, demanding environment.

Experience and/or Education Qualifications:

Associates degree in Health Information Management, preferredMedical Coding Certificate, strongly preferredAt least one of the following credentials (RHIA, RHIT, CCS, CPC, COC), strongly preferred1 to 3 years of auditing experience with preferred education.5 years of industry experience, including 1-3 years of auditing experience without preferred education.Prior behavioral health coding or auditing experience, preferred.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Brightli is a Smoke and Tobacco Free Workplace.