Description
Find your calling at Mercy! The Senior Compliance Auditor supports the Compliance Program across the Ministry, partnering with Legal, Human Resources and other business units as necessary. The audit process ensures compliance with required protocols, federal and state regulations and laws, Medicare/Medicaid, and Ministry-Wide policies. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards. Position Details:
Minimum Required Qualifications
Education:
Bachelor's Degree in a related field (nursing, HIM, healthcare administration, etc.) plus 6 years relevant auditing experience OR 10 years relevant auditing experience.
Licensure:
Experience:
6 years relevant auditing experience
Certification/Registration:
Must have one or more of the following CURRENT certifications:
• Certified Coding Specialist (CCS),
• Certified Coding Specialist – Physician (CCS-P),
• Certified Inpatient Coder (CIC),
• Certified Outpatient Coder (COC),
• Certified Professional Coder (CPC),
• Certified Risk Coder (CRC),
• Certified in Healthcare Compliance (CHC),
• Certified Documentation Improvement Practitioner (CDIP),
• Certified Professional Medical Auditor (CPMA),
• Registered Health Information Administrator (RHIA),
• Registered Health Information Technician (RHIT).
Other Skills and Knowledge:
• Advanced understanding and ability to interpret medical records, UB and/or 1500 claim forms, remittance advice, and/or the charge description master (CDM).
• Experienced working knowledge of Microsoft Word, Excel, Power Point and Outlook.
• Extensive knowledge of the False Claims Act.
• Working knowledge of EMTALA.
• In-depth knowledge in one or more of the following payment methodologies: IPF, IRF, CAH, RHC, Home Health/Hospice, Infusion/Injection coding, IPPS, OPPS, MPFS, interventional radiology coding and/or Risk Adjustment.
• Advanced knowledge and experience with rules and regulations pertaining to federally funded programs (e.g. Medicare and Medicaid) along with knowledge of documentation requirements for coding and billing.
• Strong ability to engage/interact with leadership, writing and analysis skills, and autonomous/self-starter.
Preferred Qualifications
Education:
Masters or advanced degree in a related field (nursing, HIM, healthcare administration, etc.)
Licensure:
Experience:
Experience in audit education and public speaking is strongly preferred.
Certification/Registration:
Other Skills and Knowledge:
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
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