Revenue Cycle Management Auditor

Overview

The Revenue Cycle Management Auditor is responsible for conducting comprehensive audits across all phases of the revenue cycle to ensure accuracy, compliance, and optimal reimbursement. This role focuses on identifying revenue leakage, reducing denials, and strengthening internal controls and staff productivity. The Auditor evaluates charge capture, coding accuracy, documentation integrity, billing workflows, payment posting, denial follow-up, appeals, and accounts receivable follow-up for revenue cycle management, clinical, and provider teams to drive continuous process improvement.

This is a remote position available only to candidates located in AZ, CA, NM, NV, OR, TX, and WA.

Responsibilities

• Perform routine and ad hoc audits across the full revenue cycle process, including:
  • Charge entry and charge capture accuracy
  • CPT, HCPCS, and ICD-10 coding compliance
  • Modifier usage
  • Workers’ compensation billing rules and state-specific fee schedules
  • Claim submission accuracy and clean claim rates
  • Payment posting and adjustment accuracy
  • Accounts receivable follow-up effectiveness and denial resolution workflows
• Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance
• Analyze denial trends across workers’ compensation, Medicare, and commercial payers
• Identify root causes of denials and recommend corrective actions
• Quantify revenue impact from coding errors, missed charges, underpayments, and inefficient workflows
• Ensure adherence to CMS guidelines, Medicare billing requirements, NCCI (CCI edits), payer-specific edits, state workers’ compensation regulations, and documentation standards for pain management procedures
• Support internal and external audit readiness including RAC, MAC, and payer audits
• Develop and maintain audit dashboards and key performance indicators (KPIs)
• Maintain monthly and quarterly records of all revenue cycle management, clinical, and provider audit scores and training requirements
• Collaborate with teams to develop and deliver targeted education based on audit findings
• Assist in creating and updating standard operating procedures (SOPs) and workflows to reduce errors and improve efficiency
• Establish and maintain quality assurance programs across revenue cycle management functions
• Perform routine quality assurance reviews of staff productivity and accuracy
• Recommend automation opportunities and system enhancements
• Perform other duties as assigned

Requirements

• High school diploma or equivalent required; Associate degree preferred
• Active coding certification required: CPC, CCS, or equivalent (AAPC or AHIMA)
• Minimum 5 years of experience in revenue cycle management
• At least 3 years of auditing experience within healthcare billing or coding
• Strong experience in pain management
• Knowledge of Medicare and commercial payer guidelines
• Ability to work in a fast-paced environment, meet daily deadlines, and collaborate with cross-functional revenue cycle management teams
• Excellent communication skills with the ability to present findings to providers and leadership
• Advanced understanding of NCCI edits and payer-specific billing guidelines
• High accuracy, attention to detail, analytical thinking, problem-solving skills, and strong compliance focus
• Advanced proficiency in Microsoft Excel (formulas, pivot tables) and solid skills in other Microsoft Office applications

Compensation & Benefits

• Hourly rate: $30.00 to $35.00, based on internal equity, job requirements, experience, and geographic location
• Medical, dental, vision, and prescription benefits (PPO & HMO)
• 401(k) plan with employer matching
• License and tuition reimbursements
• Paid time off, holiday pay, and floating holidays
• Employee perks and discount programs
• Supportive environment for professional growth

Location & Schedule

• Remote position available in AZ, CA, NM, NV, OR, TX, and WA
• Monday through Friday, 8:00 AM to 5:00 PM
• Full-time, 40 hours per week