• Build positive relationships with customers • Plan and carry out assessments • Take responsibility for personal development • Collaborate with colleagues and stakeholders

• Conducts independent compliance investigative audits requested by Legal or Leadership and as part of the Compliance due diligence during merger and acquisition activity • Assists in the preparation of audit reports for presentation to Legal or Leadership and presents findings and proposed action plans • Performs investigative audits and assists with response and development of corrective action plans stemming from governmental reviews and inquiries • Performs annual compliance workplan provider revenue cycle audits and projects related to the European Group • Assists in the quality review of Bon Secours Mercy Health coding, billing, and claims processing to ensure compliance with policies • Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation • Demonstrates advanced industry and audit knowledge and is recognized as a subject matter resource for the team and the ministry • Performs research, creates presentations, and otherwise supports the Revenue Cycle Compliance team with developing written reports, educational materials, and trending dashboards • Utilizes data analytics and extraction for developing trends, metrics and dashboards related to external audit activity of governmental agencies, denials, or regulatory changes • Conducts and assists with routine provider revenue cycle monitoring initiatives established from data analytics • Acts as a Superuser for audit and compliance applications and platforms • Develops standard operating procedures (SOPs) and process workflows to ensure standardization across the ministry • Responsible for training new staff on audit processes, systems, coding guidelines (to include annual and periodic coding changes), and regulatory changes impacting revenue cycle • Provides guidance and serves as resource to auditing staff regarding SOPs, coding questions, audit findings, and audit report development • Ensures that Revenue Cycle Compliance leadership is apprised of local, remote and emerging issues, adverse outcomes or deficiencies that could impact Bon Secours Mercy Health's public status • Maintains awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking • Displays a commitment to excellence, accuracy, and thoroughness in all activities and searches for way to improve and promote quality

• Handle provider disputes in a result-oriented and metrics-driven environment • Ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality • Consult and collaborate with coding professionals within and across departments • Make coding decisions based on standard industry guidelines and best practices • Manage multiple priorities, collaborate with peers and ensure timely completion of outpatient coding disputes

• Audit NOA letters for compliance with AHCCCS (Arizona Health Care Cost Containment System), CMS (Centers for Medicare & Medicaid Services), and other regulatory standards. • Ensure letters are easy to understand, free of spelling/grammar errors, and clinically accurate. • Review and validate clinical definitions and terminology used in letters. • Audit requests across multiple service types: pharmacy, medical, dental, and behavioral health. • Provide feedback to letter writers and team leads to support quality improvement. • Track audit results and identify trends or recurring issues. • Collaborate with QA (quality assurance) and Training teams to refine audit tools and update training materials. • Participate in calibration sessions to ensure consistency in audit standards. • Stay current with changes in clinical guidelines and regulatory requirements. • Assist in completing NOA letters and faxes when needed due to volume. • Help translate complex medical language into member-friendly terms.