RCM Auditor

🔥 0 minutes ago

🌵 Arizona, California, +5 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ☕ Washington – Remote

💵 $28 - $33 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Boomerang Healthcare

WebsiteLinkedInAll Job Openings

201 - 500 employees

🤝 B2B

B2B

Boomerang Healthcare is an early-stage or placeholder website for a company that appears to operate in the healthcare sector. The site currently shows a "coming soon" message and provides no public information about services, products, or target customers, so specific activities (e. g. , insurance, staffing, software) cannot be determined from the available content. The business is likely developing or preparing to launch its online presence.

📋 Description

• Audit execution & oversight by performing 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, AR follow-up effectiveness and denial resolution workflows • Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance • Denial & Revenue leakage analysis: Analyze denial trends across WC, Medicare, and commercial payers, Identify root causes of denials and recommend corrective actions, Quantify revenue impact from: Coding errors, Missed charges, Underpayments, Inefficient workflows • Ensure adherence to: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, State Workers’ Compensation regulations, Documentation standards for pain management procedures • Support internal and external audit readiness (RAC, MAC, payer audits). • Reporting & KPI development through audit dashboard Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements • Partner with all BHC teams to develop and deliver targeted education based on audit findings. • Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency • Establish and maintain quality assurance programs across RCM functions • Perform routine QA reviews of staff productivity and accuracy • Recommend automation opportunities and system enhancements • Assumes other responsibilities as appropriate to the position and organizational needs

🎯 Requirements

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

🏖️ Benefits

• Amazing work/life balance • Generous 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 help you grow and succeed