The Revenue Cycle Management CPC 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 AR follow-up for RCM, clinical, and provider teams to support continuous process improvement.
This is a remote role. The company is hiring only in AZ, CA, NM, NV, OR, TX, and WA.
What you will do
- Audit the full revenue cycle through routine and ad hoc reviews
- Review charge entry and charge capture accuracy
- Audit CPT, HCPCS, and ICD-10 coding compliance
- Evaluate modifier usage
- Review workers’ compensation billing rules and state-specific fee schedules
- Assess claim submission accuracy and clean claim rates
- Audit payment posting and adjustment accuracy
- Review AR follow-up effectiveness and denial resolution workflows
- Conduct pre-bill and post-bill audits to identify reimbursement and compliance trends
- 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 edits, payer-specific edits, and state workers’ compensation regulations
- Support internal and external audit readiness for RAC, MAC, and payer audits
- Develop reporting and KPI dashboards based on audit findings
- Maintain monthly and quarterly audit scores and training requirement records
- Partner with teams to deliver targeted education based on audit findings
- Help create and update 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
Requirements & Qualifications
Qualifications
- 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 the ability to present findings to providers and RCM leadership
- Advanced understanding of NCCI edits and payer-specific billing guidelines
- Strong accuracy, attention to detail, analytical thinking, problem-solving skills, and high integrity
- Advanced proficiency in Microsoft Excel, including formulas and pivot tables, plus solid Microsoft Office skills
Benefits & Perks
Benefits and perks
- Amazing work/life balance
- Medical, dental, vision, and prescription benefits (PPO and HMO)
- 401(k) plan with employer matching
- License and tuition reimbursements
- Paid time off
- Holiday pay and floating holiday
- Employee perks and discount programs
- Supportive environment to help you grow and succeed
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago