Compliance Audit Specialist

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 more
• Telemedicine – 24/7 phone, web, or mobile app medical, behavioral health, & dermatology visits
• Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Paid Time Off - 29 days per year including vacation & holiday pay
• Workplace 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 Plan
• Objectively 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 requirements
• Proficient in ICD-10, CPT and HCPCS coding guidelines
• Ability 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, preferred
• Medical Coding Certificate, strongly preferred
• At least one of the following credentials (RHIA, RHIT, CCS, CPC, COC), strongly preferred
• 1 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.

Position Perks & Benefits:

Paid time off: full-time employees receive an attractive time off package to balance your work and personal life

Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more

Top-notch training: initial, ongoing, comprehensive, and supportive

Career mobility: advancement opportunities/promoting from within

Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness

Brightli is on a Mission:

A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.

As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.

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 expressions, 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.