Healthcare Compliance Auditor - Enterprise RiskBon Secours Mercy Health • Bridgeport, CT, US
serp_jobs.error_messages.no_longer_accepting
Healthcare Compliance Auditor - Enterprise Risk
Bon Secours Mercy Health • Bridgeport, CT, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionAssists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and abuse. Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and / or other enforcement agencies on behalf of Bon Secours Mercy Health. Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues. Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas Assists in auditing and investigations requested by the System Director, Compliance. Assists in the development of compliance corrective action plans (CAP), oversight tools and technical edit enhancements to support revenue cycle services compliance and privacy efforts. Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. 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. Ensures that the System Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and / or deficiencies that could impact Bon Secours Mercy Health's public status. Develops educational content on documentation, coding, and trending of non-compliant activities to enhance compliance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities. CCS, CPC, RHIT, or RHIA required. Auditing Experience, Experience with EPIC Electronic Medical Records System preferred. Two to four years of in-depth experience within healthcare operations, healthcare auditing, or coding / billing either from a consulting perspective or as an employee / manager required. Demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies, as well as 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. Excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations preferred.
Compliance Auditor
Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed for Bon Secours Mercy Health.
- Please note this role is remote, but requires living in the continental US and working hours in alignment with Eastern Time.
Essential Job Functions :
Qualifications :
serp_jobs.job_alerts.create_a_job
Compliance Auditor • Bridgeport, CT, US
Job_description.internal_linking.related_jobs
Commercial Risk Account Management Leader - Norwalk, CT.As part of an industry-leading team, you will help empower results for our clients by delivering innovative and effective solutions supportin...serp_jobs.internal_linking.show_more
Maximus is looking to fill a limited service (Temp) Health Specialist position.The Health Specialist role is to provide advanced and accurate clinical inquiry responses to health related, disease c...serp_jobs.internal_linking.show_more
The Company is in search of a Chief Risk Officer (CRO) to lead its credit and risk management functions.The CRO will be tasked with developing and implementing a robust risk management program that...serp_jobs.internal_linking.show_more
Associate Director of Risk Analytics, Credit Planning 🚨.Associate Director of Risk Analytics.This is a high impact role focused on shaping credit policy through data-driven insights and portfolio ...serp_jobs.internal_linking.show_more
Wilton Re is an industry leader in the life (re)insurance space, specializing in the acquisition of in force life insurance and annuities.
We are experienced industry specialists focused on the risk...serp_jobs.internal_linking.show_more
The candidate will be responsible for designing security platforms, applications and tools to deliver against the customer Infosec strategy and programs.
Knowledge of key security domains MDR, VM, G...serp_jobs.internal_linking.show_more
A Fortune 500® company, EMCOR Group, Inc.NYSE : EME) is a leader in mechanical and electrical construction, industrial and energy infrastructure, and building services.
EMCOR companies plan, install,...serp_jobs.internal_linking.show_more
Director of Sales, Audience Measurement - Syndicated Solutions.Director of Sales, Audience Measurement - Syndicated Solutions.
The Director of Sales, Syndicated Solutions Group, is responsible for l...serp_jobs.internal_linking.show_more
We are an equal employment opportunity employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, ...serp_jobs.internal_linking.show_more
Louis Dreyfus Company is a leading merchant and processor of agricultural goods.Our activities span the entire value chain from farm to fork, across a broad range of business lines, we leverage our...serp_jobs.internal_linking.show_more
Be the spark that brightens days and ignite your career with TTEC's award-winning employment experience.Our purpose, team, and company culture are amazing and our Great Place to Work® certification...serp_jobs.internal_linking.show_more
Chief Risk Officer – To $175K – Bridgeport, CT – Job # 3468.The Symicor Group is a boutique talent acquisition firm based in Lincolnshire, IL & San Antonio, TX.
Our nationally unique value propo...serp_jobs.internal_linking.show_more
HomeServe USA is a Brookfield Infrastructure Group portfolio company.The Senior Internal Auditor will be working under the general direction of HomeServe USA's Director, Internal Audit.You are prim...serp_jobs.internal_linking.show_more
Vincent's Medical Center Bridgeport - Medefis.MedSource Travelers offers assignments nationwide and is currently seeking a qualified IR Tech with 1-2 year's experience for a travel assignment in Br...serp_jobs.internal_linking.show_more
Chief Risk Officer – To $175K – Bridgeport, CT – Job # 3468.The Symicor Group is a boutique talent acquisition firm based in Lincolnshire, IL & San Antonio, TX.
Our nationally unique value propo...serp_jobs.internal_linking.show_more
The Internal Audit Function serves as the vital third line of defense in our organization's risk management framework, complementing the roles of management (first line) and risk functions (second ...serp_jobs.internal_linking.show_more
Backus Ave, Suite 364, Danbury, CT 06810, United States (US).Sephora’s assets and support a safe, inclusive environment for clients and employees.
Working with store leaders and the District Asset P...serp_jobs.internal_linking.show_more
The role ensure Plans' operations handle customer interactions accurately and promptly, leaving a positive brand impression.
Execute audit programs and validate reported results.Present updates and ...serp_jobs.internal_linking.show_more
Commercial Risk Account Management Leader - CT
Aon • Norwalk, CT, United States
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Health Specialist (Temporary and Remote)
MAXIMUS • Bridgeport, CT, United States
serp_jobs.filters.remote
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Chief Risk Officer (CRO)
Confidential • Bridgeport, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Associate Director of Risk Analytics, Credit Planning (Norwalk)
Mitsubishi HC Capital America, Inc. • Norwalk, CT, US
serp_jobs.job_card.part_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Staff Internal Auditor
Wilton Re • Norwalk, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Cybersecurity Engagement Manager
TEPHRA • Trumbull, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Director, Internal Audit & Compliance
EMCOR Group • Norwalk, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Director of Sales, Audience Measurement - Syndicated Solutions
Ipsos in US • Norwalk, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Risk Advisor, Private Client Group
Smith Brothers Insurance • Westport, CT, United States
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Senior Internal Auditor
Louis Dreyfus • Wilton, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Seasonal Licensed Healthcare Team Lead
TTEC • Bridgeport, Connecticut, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Chief Risk Officer – Job # 3468
BritePros Medical Staffing • Bridgeport, Connecticut, United States
serp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
serp_jobs.last_updated.last_updated_30
Senior Internal Auditor
HomeServe USA • Norwalk, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
IR - Tech
St. Vincent's Medical Center Bridgeport - Medefis • Bridgeport, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Chief Risk Officer - To 175K - Bridgeport, CT - Job 3468
The Symicor Group • Bridgeport, CT, US
serp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
serp_jobs.last_updated.last_updated_30
Audit Senior
Blake Smith Staffing, LLC • Westport, CT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Asset Protection Partner
LVMH Group • Danbury, CT, United States
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Performance Audit Senior Consultant (Remote)
Blue Cross Blue Shield Association • Bridgeport, CT, United States
serp_jobs.filters.remote
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted