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Tria Federal (Tria) · 3 days ago

Revenue Integrity Audit & Compliance Specialist

United States

Full-time

Remote

Senior Level

7+ years exp

Tria Federal is a company that delivers digital services and technology solutions to support the health and safety of veterans and civilians. They are seeking a Revenue Integrity Audit & Compliance Specialist to provide expertise in revenue cycle compliance and risk-based monitoring, ensuring audit readiness across various revenue cycle processes.

ConsultingInformation Technology

No H1B

Security Clearance Required

U.S. Citizen Only

Responsibilities

Serve as an enterprise Revenue Integrity SME, providing expert guidance on audit, compliance, and control considerations across front-end, clinical, and downstream revenue cycle workflows

Lead the design and execution of risk-based monitoring and review strategies focused on registration, clinical documentation, orders, charge capture, coding, billing, and claim submission

Apply advanced expertise to evaluate control design and operational effectiveness, identifying systemic gaps, trends, and emerging risks

Conduct complex reviews of high-risk, high-dollar, or high-impact services and workflows, synthesizing findings into enterprise-level insights

Translate findings into clear, prioritized recommendations that inform governance decisions, remediation planning, and performance improvement initiatives

Advise Revenue Integrity, coding, billing, clinical, and operational leaders on root cause analysis and sustainable corrective action strategies

Support DHA leadership in preparing for and responding to internal and external audits, reviews, and inquiries (e.g., OIG, IG, payer reviews), serving as a subject matter resource

Interpret and assess the impact of regulatory and policy changes (TRICARE, CMS, OMB, DoD/DHA guidance) on revenue integrity controls and workflows

Collaborate with education and communications teams to shape targeted guidance, standards, and training based on enterprise risk patterns

Contribute expert input to the development and refinement of revenue integrity policies, procedures, control frameworks, and governance artifacts

Develop executive-level reports, dashboards, and briefings that communicate risk posture, trends, and remediation progress

Qualification

Revenue integrity expertiseHealthcare compliance knowledgeRisk-based monitoringAudit readinessFederal healthcare regulationsEHRBilling platformsExecutive communicationPublic Trust clearanceInfluencing skillsAnalytical skillsTeam collaborationProblem-solving skillsLeadership qualitiesAttention to detailAdaptability

Required

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, including enterprise or multi-facility environments

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