Revenue Integrity Audit & Compliance Specialist

Bachelor’s degree in Healthcare Administration, Business, Finance, Compliance, Nursing, or a related field; Master’s degree preferred. 7+ years of progressive experience in revenue integrity, healthcare compliance, revenue cycle oversight, audit, or monitoring roles. Demonstrated SME-level knowledge of federal healthcare billing and coding regulations, including TRICARE, CMS, and DoD/DHA policy. Proven experience designing or leading risk-based monitoring, audit, or compliance activities across complex revenue cycle workflows. Deep understanding of end-to-end revenue cycle operations, including front-end registration, clinical documentation, charge capture, coding, billing, and claim submission. Strong familiarity with EHR and billing platforms (e.g., MHS GENESIS/Cerner, claim scrubbers, clearinghouses) and related data. Ability to analyze complex scenarios, synthesize findings, and quantify financial and compliance risk. Exceptional written and verbal communication skills, with experience producing executive-ready reports and briefings. Demonstrated ability to influence without authority and operate effectively in multi-stakeholder, enterprise environments. Ability to obtain and maintain a Public Trust clearance.

Serve as an enterprise Revenue Integrity SME, providing expert guidance on audit, compliance, and control considerations. Lead the design and execution of risk-based monitoring and review strategies across revenue cycle workflows. Evaluate control design and operational effectiveness, identifying systemic gaps, trends, and emerging risks. Conduct complex reviews of high-risk services and workflows, synthesizing findings into enterprise-level insights. Translate findings into clear, prioritized recommendations that inform governance decisions and remediation planning. Advise Revenue Integrity, coding, billing, clinical, and operational leaders on root cause analysis and corrective action strategies. Support DHA leadership in preparing for and responding to internal and external audits, reviews, and inquiries. Interpret and assess the impact of regulatory and policy changes on revenue integrity controls and workflows. Contribute expert input to the development and refinement of revenue integrity policies, procedures, and control frameworks. Develop executive-level reports, dashboards, and briefings that communicate risk posture and remediation progress.