Revenue Cycle Government Audit Coordinator

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

2/23/2026

Entity:

Wisconsin

Job Code:

440103

Job Title:

Revenue Cycle Government Audit Coordinator

FLSA Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

The Revenue Cycle Government Audit Coordinator is a member of the Government Reimbursement team and is responsible for managing government billing audits in collaboration with Compliance. The role requires interpreting audit needs, determining next steps, and supporting UW Health's position, if appropriate, with written appeal and documentation. The incumbent conducts research of regulatory guidelines as published by CMS, NGS, WPS, and both Wisconsin and Illinois DHS. The RCG Audit Coordinator makes recommendations to leadership based upon research findings. This position serves on the UW External Audit Committee delivering leadership reports as appropriate.  A wide variety of internal and external contact relationships are involved in performance of the duties of this position, and the incumbent interacts with employees at all levels of the organization.

ESSENTIAL DUTIES

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Conducts research of federal, state, and voluntary regulatory standards that relate to government billing and reimbursement for Medicare and Medicaid; creates educational materials based upon research findings; Communicates findings to stakeholders.

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Assists with planning for implementation of new state and federal government requirements within the organization.

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Coordinates, manages, and supports various aspects of projects and audits involving Health and Human Services-Office of Inspector General, Department of Justice, Wisconsin –Department of Administration, Federal and State Recovery Audit Contractors, Medicare Administrative Contractors, Medicaid Integrity Program, and Supplemental Review Contractor.

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Monitors audited accounts to ensure financial resolution related to government mandated actions.

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Interprets audit findings and assertions working with appropriate stakeholders to author responses and/or draft appeals that require complex interpretation of regulation as it applies to the respective claim and medical record.

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Resolves complex government-issued rejections and denials, related to code frequency, Local Coverage Determination, and National Coverage edits.

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Aids Government Reimbursement Representatives with complex governmental denials. Works other governmental special billing denials (i.e., Hospice and Skilled Nursing Facility) as needed.

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Monitors, researches, records, and appeals Medicare ADRs (additional development requests) to ensure compliance with CMS billing and payment regulations.

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Attends and presents ad hoc to various organizational committees.

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Notifies appropriate responsible parties of audits and maintains documentation of audit requests, status, and outcomes in a centralized location.

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Tracks and trends types of audits received and report findings to Government Reimbursement Manager.

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Works collaboratively with other departments including Claims, Clinical denials, Coding and Compliance to assure complex governmental rejections and denials are researched and appealed according to governmental guidelines.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

Associate's Degree

in Business, Paralegal Studies, Coding, Communications, or another related field. Two (2) years of relevant experience in Compliance, Coding, Health Information Management, or Legal experience may be considered in lieu of an Associate degree in addition to the experience below.

Required

Bachelor's Degree

in Business, Legal Studies, Communications, Healthcare or other related field with demonstrated written and oral communication skills.

Preferred

5 years

experience within the healthcare field performing any variety of organizational, administrative, or process improvement functions.

Required

3 years

Experience reviewing and working governmental payer denials, appeal and policies.

Required

Experience in compliance, coding and/or a legal setting

Preferred

Experience or background in RAC

Preferred

Experience working with Epic

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

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Excellent oral and written communication skills.

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Efficient and effective analytical skills.

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Ability to research regulatory requirements.

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Effective human relations abilities.

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Experience with word processing, spreadsheet software, and data base management applications.

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Effective problem-solving abilities.

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Strong ability to effectively collaborative alliances and promote teamwork.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

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Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

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Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

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Medium: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

20-50#

10-25#

Negligible-10#

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Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

50-100#

25-50#

10-20#

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Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.