Senior Director, RCM & RPM Audit

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🕒 Julho 28

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OpenLoop

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2020

💼 Consultoria

⚖️ Jurídico

📦 Logística

💰 $15.000.000 Series A - OpenLoop Health em 2023-03

Consulting • Legal • Logistics

A OpenLoop é uma plataforma de telemedicina marca branca e fornecedora de serviços gerenciados que ajuda as organizações a lançar e escalar programas de atendimento virtual. Combina tecnologia SaaS personalizável (agendamento, reservas, pagamentos, integrações EHR/API) com equipe clínica, credenciamento, cobertura de pagamento e RCM, suporte regulatório/jurídico e suporte ao paciente 24/7. A OpenLoop atende planos de saúde, hospitais e sistemas de saúde, varejistas, empregadores e empresas de saúde digital com operações impulsionadas por IA, uma rede nacional de médicos e ampla cobertura de seguros, incluindo Medicare e Medicaid.

Descrição

• Provide independent, senior-level audit coverage of RCM and RPM functions. • Design and execute audit plans testing coding accuracy, claims integrity, and submission quality across the billing lifecycle. • Audit RPM enrollment eligibility, patient consent documentation, and program onboarding against CMS and payer requirements. • Partner with billing and RCM operations on corrective action — define findings, own follow-through, and confirm remediation. • Deliver the independent auditing and monitoring function required by OIG Element 6. • Build and lead a small audit team (RCM Audit Lead + RPM Compliance & Audit Analyst); set standards and develop talent. • Maintain audit-ready documentation supporting a defensible record of monitoring under OIG Element 6. • Other duties as assigned.

🎯 Requisitos

• 7–10 years in healthcare compliance, revenue cycle, or coding audit, with strong domain expertise. • Demonstrated independence — audit experience separate from compliance program design. • Deep working knowledge of CMS billing rules and RPM CPT requirements (99453, 99454, 99457, 99458). • Familiarity with OIG guidance on effective compliance programs (Seven Elements), particularly Element 6. • Experience auditing telehealth or remote monitoring programs strongly preferred. • CPC, CHC, CPCO, AHIMA coding credential, or equivalent a plus. • Ability to translate audit findings into executive-ready risk summaries — findings reports that drive action, not confusion. • Comfortable building a function from the ground up; systems thinker who is calm in ambiguity. • High integrity and sound judgment; low-ego collaborator who partners well with Billing, RCM Operations, and Legal.

🏖️ Benefícios

• Medical, Dental, and Vision plans • Flexible Spending/Health Savings Accounts • Flexible PTO • 401(k) + Company Match • Life Insurance, Pet insurance, and more