Professional Billing Auditor – Surgical Specialty

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Sage Clinical RCM, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2024

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Sage Clinical RCM is a healthcare revenue cycle management company that combines proprietary technology with clinical and financial expertise to provide end-to-end RCM solutions—from patient access through financial close. The firm offers advisory services, revenue cycle management operations, technology adoption (including clinical documentation improvement and autonomous coding), workforce augmentation (coding, documentation, RCM, physician advisory), and analytics-driven platforms (Sage IQ: Validity and VERO) that use automation and AI to unify coding, documentation, vendor performance, compliance, and financial reporting for healthcare organizations.

📋 Description

• Provide ongoing audit support for hospital-based physician billing with a focus on complex surgical services • Perform retrospective and/or concurrent audits of professional billing surgical claims • Review operative reports and supporting documentation to validate appropriate CPT, HCPCS, and ICD-10-CM code assignment • Validate modifier usage and bundling in accordance with NCCI edits and payer guidelines • Identify surgical coding trends, compliance risks, and opportunities for improvement • Provide clear, educational feedback to professional billing coders related to surgical coding accuracy • Document audit findings and recommendations in accordance with established audit standards • Support internal and external audit preparedness related to professional fee surgical services • Ensure compliance with CMS, AMA, and payer-specific billing regulations

🎯 Requirements

• Minimum 2+ years of professional billing auditing experience with a focus on surgical services • Strong knowledge of CPT (Surgery section), ICD-10-CM, modifiers, and NCCI edits • Experience auditing hospital-based physician surgical billing claims • CPC, CPMA, or equivalent certification preferred • Strong written and verbal communication skills with the ability to provide constructive audit feedback