Job Description:

Job Title: Compliance Audit SpecialistLocation: Springfield, MO

Department: Compliance and IntegrityEmployment Type: Full-timeShift: Monday - Friday 8:00 A.M. - 5:00 P.M.

Job Summary:

Join our mission to deliver exceptional healthcare services with integrity. As a Compliance Audit Specialist, you will play a vital role in ensuring our organization's adherence to regulatory standards and ethical practices. Your attention to detail and analytical skills will contribute to maintaining the highest levels of compliance, fostering trust with our patients and communities we serve.

This position offers an opportunity to be part of a dynamic team dedicated to excellence. We are seeking individuals with a keen eye for detail, strong problem-solving abilities, and a commitment to upholding ethical and compliant practices in the healthcare industry.

Springfield, Missouri, offers a vibrant community with a rich cultural scene, outdoor recreation opportunities, and a high quality of life. Explore all that this charming city has to offer while pursuing a rewarding career with our organization.

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:

• Conduct comprehensive reviews of medical records and documentation supporting claims for medical and behavioral health care services

• Evaluate completeness of medical record documentation to support billing of services under Federal health care programs

• Review documentation for medical necessity, accurate diagnosis and procedure codes, proper payor responsibility, and supplemental information

• Identify and report abnormal billing patterns and indicators of potential fraud and abuse

• Assist in audits related to Compliance investigations for potential overpayments

• Present findings and recommendations regarding coding and billing appropriateness professionally

• Recommend corrective actions for deficiencies, including policy and procedure improvements

• Utilize problem-solving strategies to enhance compliant coding and billing practices

Education and/or Experience Qualifications:

• Associate's degree in Health Information Management preferred

• Medical Coding Certificate strongly preferred

• One of the following credentials preferred: RHIA, RHIT, CCS, CPC, COC

• 1-3 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

Additional Qualifications:

• Successful completion of background check, including criminal record, driving record, and abuse/neglect

• Completion of New Hire Orientation and Relias Learning training

• Current driver's license, acceptable driving record, and current auto insurance

Keywords: Compliance Auditor, Healthcare Auditing, Medical Coding, Regulatory Compliance, Fraud Detection, Documentation Review, Billing Compliance, RHIA, RHIT, CCS, CPC, COC

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.

Preferred Family Healthcare is a Smoke and Tobacco Free Workplace.

About Brightli

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 use care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. We are doing this by forming a new behavioral health organization under new model. Under one parent company, multiple organizations are able to collaborate, share resources and system supports, increase recruiting and retention efforts, increase access to specialized care, and meet the growing demand for behavioral and addiction recovery care.

Brightli’s top-line subsidiaries include Burrell Behavioral Health (Burrell), Preferred Family Healthcare (PFH), and Southeast Missouri Behavioral Health (SEMO). While these organizations operate independently and are governed by separate board of directors, their operations and services benefit from this model. Alone, organizations may be able to navigate the current tumultuous healthcare environment, but we believe that together we can do so much more than survive. Our communities need us now more than ever, and by working together we are ready to answer their call for years to come.

Brightli Snapshot

• 200 locations

• 4 states

• 19 subsidiaries and/or affiliates

• 5k+ employees