Revenue Cycle Audit & Compliance Specialist (Hybrid)

Care Compass Network • City of Binghamton, NY

12h • Hybrid

About The Position

Reporting to the Director of Revenue Cycle, this position will design and operate Care Compass’s monitoring program for NYS OMIG/OIG requirements, audit readiness, internal controls, and data validation across NYHER/HRSN and Behavioral Health Hubs. This position will partner closely with the Director of Revenue Cycle to ensure policies, SOP’s and evidence, support clean claims, accurate reimbursement and rapid corrective actions.

Requirements

• Associate’s degree in healthcare administration, Business, or related field (Bachelor’s degree, preferred).
• Minimum 5-7 years in healthcare compliance/auditing (medical focus).
• Experience with OMIG program integrity and OIG guidance, preferred
• Strong command of documentation standards, coding/billing rules and audit techniques.
• Advanced Excel, working SQL for data validation, and Power BI for monitoring.

Nice To Haves

• Familiarity with NYHER/HRSN programs, behavioral health billing context, and Social Care Network workflows
• Experience with UniteUs, Millin, and clearinghouse data flows.

Responsibilities

• Author and maintain revenue cycle compliance policies, billing standards, and SOP’s; coordinate change management and training cadence.
• Build a risk-based auditing program (prospective and retrospective): sample design, test procedures, documentation review, root-cause analysis and CAP tracking.
• Validate data integrity from encounter through 837/835.
• Reconcile system feeds (HER/referral platforms/clearinghouse) to financials.
• Lead audit readiness for OMIG/OIG, MCO and internal audits.
• Prepare evidence binders, respond to requests and report outcomes.
• Partner with the Director of Revenue Cycle on denial analytics, ensuring compliance risks are flagged and remediated.
• Support Business Solutions assessments with compliance scoring, policy mapping and risk mitigation plans.
• Conduct quarterly compliance training(s); maintain logs and attestations.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees