Senior Revenue Compliance Auditor

At Children’s Wisconsin, we believe kids deserve the best.

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

Children's Wisconsin has an opportunity for a Senior Revenue Compliance Auditor on our team.

Location: Remote

What you will do:

Responsible for researching, analyzing, monitoring and auditing charging and billing processes, quality of documentation to support billing, and coding and billing practices for professional and technical services to help ensure compliance with applicable policies and procedures and healthcare billing regulations. In addition, this role will be responsible for identifying and facilitating implementation of best practices, process improvements, internal controls, and corrective actions when appropriate. This role will work collaboratively with Revenue Cycle, Financial Services, Health Information Management and the clinical areas as needed and will actively participate on teams formed to examine applicable elements of the Revenue Cycle.

ESSENTIAL FUNCTIONS:

• Exhibits guiding behaviors that reflect Children’s values and support our mission and vision.

• Performs reviews and investigations of regulatory requirements and guidelines, and internal controls or processes to ensure compliance for documentation, charging, coding, reimbursement, and billing.

• Monitors developments and changes in federal and state regulation, policy, guidelines, industry best practices, and technological advancements related to charge capture, documentation, billing, coding, and reimbursement. Communicates this information to all applicable parties in a timely manner for appropriate follow-up actions.

• Collaborates with all clinical and operational departments involved in coding, billing, and reimbursement activities to improve charging, coding and billing compliance and effectiveness.

• Serves as an institutional subject matter expert and authoritative resources on interpretation and application of documentation and coding rules and regulations, and payer requirements and policies.

• Evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third-party payer billing rules, and OIG compliance standards.

• Participates on teams assembled to respond to government and commercial audits of claims; facilitates submission of records and resolution as needed and maintains documentation.

• Identifies risks related to compliance with billing regulations and revenue capture, including risk evaluation of proposed or actual changes in operational or clinical documentation, coding, or billing practices.

• Participates in annual enterprise risk assessments of potential and detected charging, coding and billing compliance deficiencies.

• Oversees data analysis used to identify trends, issues, and risk areas related to coding and billing compliance, and conducts compliance auditing/monitoring activities.

• Meets as needed with the nursing areas and other clinical departments to discuss issues that are identified during ongoing monitoring/auditing.

• Helps develop corrective action plans and works with applicable areas to ensure action plans can be implemented in an efficient and effective manner.

• Serves as a member of cross-functional teams to provide technical expertise related to coding and billing compliance for all patient charges.

• Presents results of audits and special projects to management. 

• Perform other duties or special investigations as assigned.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

• Bachelor’s degree required.

• Healthcare industry revenue cycle, billing, denials, and coding background with a minimum of five years’ experience. Professional certification preferred (Certificate in Healthcare Compliance, Certified Professional Coder, Certified Coding Specialist, Certified Internal Auditor, or equivalent).

• Understanding of hospital and physician coding and billing practices required, as well as payer guidelines including Medicaid and Medicare. Demonstrated knowledge of correct coding principles (CCI/OCE edits) of CPT, ICD10, HCPCS and modifier selections, as well as revenue codes.

• Thorough knowledge of clinical documentation requirements, ICD-10, and DRG assignment and the impact of these requirements on the revenue cycle and operations.  Knowledge of Epic systems and coding software. 

• Ability to collect, analyze, and evaluate information pertaining to revenue cycle compliance.

• Excellent oral and written communication skills to communicate effectively with all levels of management, staff and outside individuals to ensure risk mitigation strategies are appropriate and effective.

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses: