Tria Federal is seeking a Revenue Integrity Audit & Compliance Specialist to support the Defense Health Agency’s (DHA) enterprise Revenue Integrity (RI) initiatives. This role provides subject matter expertise in revenue cycle compliance, risk-based monitoring, and audit readiness across the front-end, clinical, and downstream revenue cycle, including charge capture, coding, billing, and claim submission.

The role operates at an enterprise level, applying expert judgment to evaluate revenue integrity risk, assess control effectiveness, and guide remediation strategies that strengthen audit readiness and sustain compliant revenue capture across the Military Health System (MHS).

**This opportunity is contingent upon award.**

Key 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.

Required Skills & Experience:

• 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.

Preferred Qualifications:

• Professional certification such as CHC, CHC-C, CPC, CCS, CPMA, or equivalent.
• Direct experience supporting Defense Health Agency or Military Health System revenue cycle or compliance initiatives.
• Experience advising senior leaders on enterprise audit readiness and control frameworks.
• Familiarity with DHA/MHS revenue cycle data sources and reporting tools.