RCM Auditor

This is a fully remote position, open to applicants in Arizona, +6 more states.

📋 Description

• Execute and oversee audits by conducting routine and ad hoc evaluations throughout the entire revenue cycle process, which includes: Charge entry and charge capture accuracy, compliance with CPT, HCPCS, and ICD-10 coding, proper modifier usage, adherence to workers’ compensation billing rules and state-specific fee schedules, accuracy in claim submissions and clean claim rates, payment posting and adjustment accuracy, as well as effectiveness in AR follow-up and denial resolution workflows.

• Perform pre-bill and post-bill audits to uncover trends affecting reimbursement and compliance.

• Conduct denial and revenue leakage analysis: Examine denial trends across WC, Medicare, and commercial payers, identify root causes of denials and suggest corrective measures, quantify revenue impacts resulting from: coding errors, missed charges, underpayments, and inefficient workflows.

• Ensure compliance with: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, state workers’ compensation regulations, and documentation standards for pain management procedures.

• Facilitate readiness for internal and external audits (RAC, MAC, payer audits).

• Develop reporting and KPIs through an audit dashboard, maintaining monthly and quarterly records of all RCM, clinical, and provider audit scores and training prerequisites.

• Collaborate with all BHC teams to create and deliver targeted educational initiatives based on audit results.

• Assist in the formulation and updating of SOPs and workflows to minimize errors and enhance efficiency.

• Establish and uphold quality assurance programs throughout RCM functions.

• Conduct routine QA reviews of staff productivity and accuracy.

• Propose opportunities for automation and system improvements.

• Take on additional responsibilities as required by the position and organizational needs.

⛳️ Requirements

• High school diploma or equivalent is required; an associate degree is preferred.

• Active coding certification is required: CPC, CCS, or equivalent (AAPC or AHIMA).

• A minimum of 5 years of experience in revenue cycle management.

• At least 3 years of auditing experience in healthcare billing or coding.

• Strong background in pain management.

• Familiarity with Medicare and commercial payer guidelines.

• Capability to thrive in a fast-paced environment, meet daily deadlines, and collaborate effectively with cross-functional RCM teams.

• Excellent communication skills, with the ability to present findings to providers and RCM leadership.

• Advanced knowledge of NCCI edits and payer-specific billing guidelines.

• High accuracy and attention to detail, along with strong analytical thinking, problem-solving abilities, and a commitment to integrity and compliance.

• Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications.

🏝️ Benefits

• Exceptional work/life balance.

• Comprehensive Medical, Dental, Vision, and Prescription benefits (PPO & HMO).

• 401(K) Plan with Employer Matching.

• License & Tuition Reimbursements.

• Paid Time Off.

• Holiday Pay & Floating Holiday.

• Employee Perks and Discount Programs.

• Supportive environment to foster your growth and success.