Senior Auditor, Revenue Optimization

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee daily functional leadership and provide technical assistance to Revenue Optimization Auditors.

• Act as the main Subject Matter Expert regarding audit processes, as well as inquiries related to coding and billing, departmental policies, and workflow requirements.

• Offer support on complex cases, manage workload coordination, reinforce departmental standards, and escalate critical issues to the Manager.

• Conduct and assist in intricate revenue optimization audits that encompass coding, billing, documentation, revenue integrity, and assigned audit tasks.

• Assess records for precision, completeness, compliance with standards, under-coding, over-coding, missed billing chances, documentation gaps, and compliance issues.

• Execute scheduled quality assurance evaluations of auditor performance.

• Provide constructive feedback, pinpoint trends that necessitate education or clarification of processes, and relay significant findings to management.

• Create, review, and present audit findings and supporting examples to management and stakeholders.

• Summarize findings, revenue opportunities, coding and documentation patterns, compliance factors, root causes, and necessary corrective or preventive measures.

• Utilize reporting and data analytics tools to examine audit populations and extensive datasets, identify trends and irregularities, and assess revenue integrity issues.

• Offer coaching, training, and technical support to Auditors, Coders, Physicians, and other involved parties.

• Assist in the onboarding and development of new Revenue Optimization Auditors through workflow training, technical instruction, mentoring, case reviews, and feedback.

• Recognize opportunities to enhance audit methodologies, standardize workflows, increase quality and efficiency, improve reporting, and optimize revenue cycle outcomes.

• Organize and engage in team, departmental, and management meetings.

• Share operational updates, facilitate the resolution of escalated issues, and support the Manager with priorities, coverage needs, and operational duties.

• Function as a senior subject matter expert and daily functional leader within the Revenue Optimization Audit team.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• Current CPC or CCS certification, in addition to CPMA, CANPC, or an equivalent professional auditing or anesthesia coding certification.

• At least 5 years of professional medical coding, auditing, revenue integrity, or revenue cycle experience, with substantial experience in auditing anesthesia services.

• In-depth knowledge of anesthesia coding, billing, documentation, and reimbursement requirements.

• Proficiency in interpreting and applying CPT, ASA Crosswalk, ICD-10-CM, HCPCS, payer guidelines, CMS recommendations, and other relevant coding and billing regulations.

• Experience in executing coding, documentation, revenue optimization, or compliance-focused audits.

• Strong analytical abilities to evaluate complex information, identify trends and root causes, and convert findings into actionable recommendations.

• Capability to provide technical guidance, coaching, training, and constructive feedback.

• Excellent written and verbal communication skills.

• Strong organizational and time-management capabilities.

• Sound judgment, professionalism, discretion, and the ability to appropriately escalate operational or compliance issues.

• Proficient in Microsoft Excel and other Microsoft Office applications.

• Ability to effectively work with audit, reporting, revenue cycle, and data analytics systems.

• Capacity to work independently in a remote setting while ensuring effective communication and collaboration.

• Previous experience as a team lead, senior auditor, subject matter expert, trainer, or in a similar functional leadership role is preferred.

• Experience conducting internal or external coding audits, revenue optimization audits, payer audits, or revenue integrity reviews is preferred.

• Experience in developing audit reports, presenting findings to leadership, and providing education based on audit outcomes is preferred.

• Experience analyzing audit data and identifying overall revenue, coding, documentation, or workflow trends is preferred.

🏝️ Benefits

• Paid Time Off

• Health insurance

• Life insurance

• Vision insurance

• Dental insurance

• Disability insurance

• AD&D insurance

• Flexible Spending Accounts/Health Savings Accounts

• 401(k)

• Opportunities for leadership and professional development

• Remote work environment