Auditor

• Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy, CPT, HCPCS, and ICD-10 coding compliance, Modifier usage, Workers’ compensation billing rules and state-specific fee schedules, Claim submission accuracy and clean claim rates, Payment posting and adjustment accuracy, AR follow-up effectiveness and denial resolution workflows
• Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance
• Denial & Revenue leakage analysis: Analyze denial trends across WC, Medicare, and commercial payers, Identify root causes of denials and recommend corrective actions, Quantify revenue impact from: Coding errors, Missed charges, Underpayments, Inefficient workflows
• Ensure adherence to: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, State Workers’ Compensation regulations, Documentation standards for pain management procedures
• Support internal and external audit readiness (RAC, MAC, payer audits).
• Reporting & KPI development through audit dashboard Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements
• Partner with all BHC teams to develop and deliver targeted education based on audit findings.
• Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency
• Establish and maintain quality assurance programs across RCM functions
• Perform routine QA reviews of staff productivity and accuracy
• Recommend automation opportunities and system enhancements
• Assumes other responsibilities as appropriate to the position and organizational needs

RCM Auditor

• Develops pre-audit analysis, identifies issues, and schedules the necessary appointments.
• Uses independent judgment to determine the scope and techniques of the audit; develops audit plans and performs sampling techniques in order to test the accounting system.
• Conducts in person, virtual, telephonic or correspondence audits to determine the appropriate adjustment of tax including business income and expenses reported on individual income tax returns by examination of the financial books and records, including tracing receipts and expenses and matching to and from source documents.
• Evaluates internal controls to determine if they are sufficient to properly account for income and expenses.
• Ensures that the accounting transactions conform with generally accepted accounting principles as well as state, federal, and local tax laws, rules, and regulations by reviewing treatment of issues or returns.
• Audits may include single issues, complex issues, business, and non-complex partnership.
• Research, interpret and apply federal, state and local laws (e.g. Internal Revenue Code (IRC), Oregon Revised Statutes (ORS)), regulations, Revenue Rulings, and applicable federal and Oregon court decisions by using reference material accessible on both paper and/or on-line computer systems to recognize, and resolve tax issues.
• Prepares audit work papers, audit reports, and makes changes to a taxpayer's return into a computer system. Such work papers include a full disclosure of the scope and techniques used in the examination, information to support the auditor's conclusions and opinions, and full explanation of any changes made to taxpayer's taxable income and tax liability.
• Presents findings of audit to the taxpayer and/or representative.

Tax Auditor 1 – Entry Level

• Conduct audits to evaluate compliance with a wide variety of Federal and State laws, regulatory rules & regulations, PSJH policies and procedures.
• Collaborate with Case Management, Utilization Review, Revenue Integrity, Clinical Risk, Internal Legal Affairs and Finance under supervision.
• Navigate and analyze data across Clinical EMR and Epic Billing systems, reviewing line-item charges and supporting documentation.
• Present audit findings collaboratively to reduce risk within Providence as a system.

Compliance Auditor

• The Performance Principal Auditor organizes and leads the execution of performance and compliance audits of various state agencies under the general direction and oversight of an Audit Manager.
• Gather, collect, and assemble information to obtain an understanding of the organization or program under audit.
• Identify and interview key agency or program managers and staff, stakeholders, legislative staff, legislators and experts in the field of study.
• Determine the scope of audits, identify audit objectives, and write audit plans by identifying procedures to follow to achieve audit objectives.
• Give direction on work procedures and review the work of lower-level audit staff members.
• Provide on-the-job training and coaching to the staff and provide informal assessment of lower-level staff to the audit manager and elevate performance issues to the audit manager when needed.
• Analyze and synthesize a broad array of quantitative and qualitative information on an organization or program’s resources, workload, and results to prepare recommendations on operational, budgetary, organizational, and other administrative matters.
• Write and/or oversee writing audit reports and/or management letters and present audit results to auditees and others charged with governance such as audit and legislative committees.

Performance Principal Auditor – State Principal Auditor

• delivering BSI’s audit services to assigned clients in accordance with all BSI, scheme and regulatory requirements to assure timely, cost-effective service delivery that assures satisfaction of our customer needs
• conduct various types of audits
• Prepare assessment reports and deliver findings to clients to ensure client understanding of the assessment decision and clear direction to particular items of corrective action where appropriate
• Recommend the issue, re-issue or withdrawal of certificates, and report recommendations in accordance with BSI policy, procedures and prescribed timeframe
• Maintain overall account responsibility and portfolio accountability for nominated accounts to ensure an effective partnership, whilst ensuring excellent service delivery and account growth
• Lead assessment teams as required, ensuring that team members are adequately briefed to maintain quality of service and that effective working relationships are sustained both with Clients and within the team
• Responsible for contacting clients and scheduling the visits, planning the assessments, making travel plans, conducting the assessments, reporting and managing the results
• Responsible for attending any required training and following all procedures, processes, policies within BSI for management of clients, management of a home-based office, use of BSI equipment and communication both internal and external to the organization
• Responsible for monitoring the client accounts to ensure that records, visit cycle, invoicing and other related matters are properly dealt with to assure client satisfaction is maintained
• Responsible for leading teams, when necessary, and mentoring and coaching new or inexperienced colleagues as needed to meet the business needs.

Aerospace Management Systems Auditor

• Assists the Company in accomplishing its strategic objectives by evaluating and improving organizational governance.
• Performs assigned audit test work in accordance with the approved audit program on financial, operational, and compliance audits and projects within budgeted timeframes.
• Monitors the progress of work assigned to others, provides assistance and guidance, and reviews work performed to ensure objectives are met.
• Analyzes accounting records, operations, policies, and procedures to determine validity of financial records and effectiveness of controls.
• Applies appropriate audit procedures to ensure controls are tested, and risks addressed.
• Identifies and presents audit issues and recommendations in various levels of management.

Internal Auditor

• Assist in identifying, analyzing, and assessing risk throughout Mercury and contribute to the development of the annual audit plan
• Scope and plan multiple audits across Mercury products and operations
• Conduct process walkthroughs and execute audit testing to confirm the design and operational effectiveness of internal controls
• Assess compliance with Mercury’s compliance obligations
• Socialize, document, and report audit issues identified
• Collaborate with teams to develop appropriate action plans, track audit issue remediation, and conduct issue follow up testing
• Other duties as assigned

Senior Internal Auditor

• Review automated audit results and documentation and make adjustments to audit results when necessary.
• Forward audit recommendation to claims adjuster for final review and payment determination.
• Research medical audit and system issues and communicate this information with recommended actions.
• Explain pertinent laws, rules, and policies to internal and external customers.

Medical Auditor II

• Develop, evaluate, lead, and perform multiple and diverse performance audit programs to monitor and regulate the workers' compensation industry
• Ensure public funds are disbursed properly by reviewing payroll and financial records
• On-site and virtual remote audits, ranging from simple to complex, are conducted at claims processing locations
• Act as a resource to the workers' compensation industry, providing training and consultation relating to workers' compensation issues

Auditor, Compliance Specialist 2

• The Revenue Cycle Auditor is responsible for providing patient focused, standardized, compliant revenue cycle support that will assist Providence St Joseph Health in meeting financial objectives.
• Join our team at Revenue Cycle Business Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect.

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