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 is critical in identifying revenue leakage, reducing denials and strengthening internal controls and staff productivity requirements. The Auditor will evaluate 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 drive continuous process improvement.
*This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA.
What you will do:
- Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including:โฏ
- Charge entry and charge capture accuracyโฏ
- CPT, HCPCS, and ICD-10 coding complianceโฏ
- Modifier usageโฏ
- Workersโ compensation billing rules and state-specific fee schedulesโฏ
- Claim submission accuracy and clean claim ratesโฏ
- Payment posting and adjustment accuracyโฏ
- AR follow-up effectiveness and denial resolution workflowsโฏ
- Conduct pre-bill and post-bill audits toโฏidentifyโฏtrendsโฏimpactingโฏreimbursement and complianceโฏ
- Denial & Revenue leakage analysis:โฏ
- Analyze denial trends across WC, Medicare, and commercial payersโฏ
- Identifyโฏroot causes of denials and recommend corrective actionsโฏ
- Quantify revenue impact from:โฏ
- Coding errorsโฏ
- Missed chargesโฏ
- Underpaymentsโฏ
- Inefficient workflowsโฏ
- Ensure adherence to:โฏ
- CMS guidelines and Medicare billing requirementsโฏ
- NCCI (CCI edits) and payer-specific editsโฏ
- State Workersโ Compensation regulationsโฏ
- Documentation standards for pain management proceduresโฏ
- Support internal and external audit readiness (RAC, MAC, payer audits).โฏ
- Reporting & KPI development through audit dashboardโฏ
- Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirementsโฏ
- Partner with all BHC teams to develop and deliver targeted education based on audit findings.โฏ
- Assistโฏin creating and updating SOPs and workflows to reduce errors and improve efficiencyโฏ
- Establish andโฏmaintainโฏquality assurance programs across RCM functionsโฏ
- Perform routine QA reviews of staff productivity and accuracyโฏ
- Recommend automation opportunities and system enhancementsโฏ
- Assumes other responsibilities as appropriate to the position and organizational needs
Qualifications:
- High school diploma or equivalent required; Associate degree preferredโฏ
- Active coding certificationโฏrequired: CPC, CCS, or equivalentโฏ(AAPC or AHIMA)โฏ
- 5+โฏyears of experienceโฏinโฏrevenue cycle managementโฏโฏ
- 3+ years of auditing experience within healthcare billing or codingโฏ
- Strong experience in pain managementโฏ
- Experience with Medicare and commercial payer guidelinesโฏ
- Ability to work in a fast-pacedโฏenvironment, meet daily deadlines, and collaborate with cross-functional RCM teamsโฏ
- Excellent communication skills with ability to present findings to providers and RCM leadershipโฏ
- Advancedโฏunderstanding ofโฏNCCI edits and payer-specific billing guidelinesโฏ
- Accuracy and attention to detail, analytical thinking and problem solvingโฏand high integrity and compliance focusโฏ
- Advancedโฏproficiencyโฏin Microsoft Excelโฏ(e.g., formulas, pivot tables) and solid skills in other Microsoft Office applicationsโฏ
Compensation Range:โฏ
$28.00 to $33.00 Hourly
All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations.
Why You'll Love Working Here:
- 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
Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC.โฏ
Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us.