Healthcare Compliance Auditor, Senior I

UPMC Senior Communities • $75K — $95K *
Pittsburgh, PA 15237In-Person
Healthcare
Less than 5 years of experience
1 week ago
Job Overview by Ladders

Qualifications

  • Bachelor's degree or equivalent clinical certification with 3 years of progressive experience in clinical, audit, or compliance roles, or a High School Diploma/GED with 7 years of related experience
  • Demonstrated expertise in healthcare operations
  • Strong executive communication and influence skills
  • Preferred experience in Revenue Cycle, utilization review, and clinical operations
  • Superior computer skills, particularly in MS Office: Word, Excel, Outlook, PowerPoint, CoPilot, and SharePoint
  • Strong understanding of risk analysis and process improvement
  • Willingness to travel to UPMC facilities within the tri-state area

Responsibilities

  • Conduct independent research on healthcare billing and compliance regulatory requirements
  • Review clinical documentation and practices to identify compliance risks
  • Monitor and validate corrective actions for compliance
  • Engage with clinical, operational, revenue cycle, and compliance stakeholders for process evaluations
  • Develop and deliver compliance education related to audit findings
  • Maintain detailed audit workpapers according to departmental standards
  • Stay updated on regulatory changes to assess organizational impact

Benefits

  • Hybrid work model combining remote work with on-site attendance
  • Supportive collaboration with diverse departments
  • Opportunities for professional development and training
  • Engagement with a reputable institution dedicated to compliance excellence
  • Exposure to various regulatory environments and healthcare systems
Full Job Description
The Healthcare Compliance Auditor Senior I plays a key role in supporting UPMC's compliance and regulatory oversight activities through the identification, assessment, and mitigation of healthcare compliance risks. Leveraging expertise in healthcare operations, reimbursement methodologies, and regulatory requirements, this position conducts auditing and monitoring activities and collaborates with clinical, operational, revenue cycle, and compliance stakeholders to promote adherence to regulatory requirements. This is a full-time position that works Monday through Friday during normal business hours. The role follows a hybrid work model, with a combination of remote work and on-site attendance at UPMC's USX office.

Responsibilities:

  • Must have knowledge of medical terminology, HIM coding, and reimbursement methodologies.
  • Has working knowledge of internal policies and external regulatory requirements (e.g., Medicare, Medicaid, DOH, and other applicable authorities).
  • Conducts independent research on Medicare, Medicaid, and other regulatory requirements impacting billing and compliance.
  • Understands patient flow and care in a clinical setting, healthcare billing and healthcare compliance issues.
  • Reviews clinical documentation, coding, billing, and reimbursement practices to identify potential compliance risks and opportunities for improvement.
  • Monitors and validates the implementation of corrective actions to ensure sustained compliance.
  • Conducts follow-up reviews to validate the effectiveness and sustainability of corrective action plans.
  • Collaborates with clinical, operational, revenue cycle, and compliance stakeholders to evaluate processes and ensure adherence to regulatory requirements and organizational standards.
  • Supports compliance risk assessments and reviews, as assigned.
  • Maintains detailed audit workpapers and supporting documentation in accordance with departmental standards.
  • Develops and delivers compliance education and training related to audit findings.
  • Monitors regulatory updates and industry guidance to identify emerging risks and assess organizational impact.
  • Interprets and applies federal and state healthcare regulations, payer requirements, coding guidelines, and organizational policies to audit activities.
  • Maintains effective verbal and written communication skills with the ability to engage stakeholders across all organizational levels.
  • Contributes to the department's reputation through high-quality work, collaboration, and adherence to compliance principles.


Qualifications:

  • Bachelor's degree or equivalent clinical certification and Three (3) years of progressive clinical, audit, or compliance experience
    • OR High School Diploma/GED and Seven (7) years of related work experience.
  • Demonstrated expertise in healthcare operations
  • Strong executive communication and influence skills
  • Prior experience within Revenue Cycle preferred
  • Experience with utilization review preferred
  • Prior experience with clinical operations preferred
  • Superior computer skills, including experience in MS Office tools: Word, Excel, Outlook PowerPoint, CoPilot and SharePoint
  • Strong understanding of risk analysis and process improvement
  • Willingness to travel, as needed to UPMC facilities within the tri state area
    Licensure, Certifications, and Clearances:
  • Act 34
  • Relevant professional license is required (RN/LPN or equivalent).
  • Relevant professional certification is preferred. (Six Sigma, Certification in Health Care Compliance (CHC), billing or coding certificate, Clinical Documentation Improvement Specialists (CDI) all others will be considered)

About UPMC Senior Communities

UPMC Senior Communities Careers

There has never been a better time to explore the diverse job opportunities at UPMC Senior Communities—the leading network of senior living facilities focused on innovative care and professional excellence.

Work You’ll Do

Join UPMC Senior Communities to assist in transforming the experience of aging through top-tier care and wellness programs. This is an opportunity to be part of a team that values leadership, diversity, and innovation in the healthcare sector. Lead in a unique role where skills in healthcare, empathy, and leadership converge to enhance the lives of seniors. UPMC Senior Communities stands at the forefront of the industry, integrating advanced technology and personalized care practices. Engage with a professional network of healthcare providers and administrators dedicated to pioneering improvements in senior living. Collaborate with over 3,000 dedicated professionals across various facilities.

Introducing the UPMC Senior Communities Professional Development Program

The program is designed to foster career growth through comprehensive training, leadership development, and diversity training. UPMC Senior Communities is committed to nurturing the professional growth of its team members through continuous education and opportunities for advancement.

Do Innovative Work

Be part of a culture that thrives on innovation and continuous improvement. UPMC Senior Communities employs a vast array of healthcare professionals and support staff, all dedicated to setting new standards in senior care.

Drive Change in Senior Healthcare

Deliver targeted solutions and personalized care that significantly improve the quality of life for residents. UPMC Senior Communities offers a platform for professionals to apply their expertise in a meaningful and impactful way.

Be Part of a Great Team

Work alongside a team that values compassion and professionalism, harnessing the collective capabilities to deliver exceptional care. UPMC Senior Communities promotes a collaborative environment where every team member’s contribution is valued.

Future-Proof Your Career

Advance your career within UPMC Senior Communities through a variety of pathways, from direct care positions to administrative roles. Enjoy robust benefits, professional development programs, and a supportive work environment that encourages long-term career growth.

Explore

Discover how UPMC Senior Communities leads the way in senior healthcare innovation: - Implementing cutting-edge health technology to enhance resident care - Developing community-based programs that support holistic wellness

The UPMC Senior Communities Employment Promise

With a commitment to employee satisfaction and career development, UPMC Senior Communities ensures that all team members have the resources and support to succeed. Clients and their families rely on UPMC Senior Communities for compassionate and skilled care, making it a prime choice for those seeking meaningful employment in the healthcare sector.

Stay Connected

Join the Team

Search open positions that match your skills and interests. UPMC Senior Communities looks for passionate, curious, creative, and solution-driven team players. SEARCH UPMC SENIOR COMMUNITIES JOBS

Keep Up to Date

Stay ahead with career tips, insider perspectives, and industry-leading insights you can put to use today—all from the people who work at UPMC Senior Communities.

READ CAREERS BLOG

Job Alert Emails

Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UPMC Senior Communities.
Learn more about UPMC Senior Communities
Industry
Hospitals & Medical Centers
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at UPMC Senior Communities

More Healthcare Jobs

Find similar Healthcare Compliance Auditor, Senior I jobs:

NationwidePittsburgh, PA