Manager of Revenue Cycle & Compliance

Koya Medical, Inc.

2d•$120,000 - $135,000•Remote

About The Position

Koya Medical is seeking a hands-on Manager of Revenue Cycle & Compliance to lead compliance oversight and independent reviews across its durable medical equipment (DME) order-to-payment lifecycle, from intake and documentation through authorization, delivery, billing, appeals, and patient financial responsibility. The Manager independently designs risk-based audits, analyzes data, investigates revenue-cycle patient complaints, and coordinates external payer audits. The role develops practical controls, validates corrective actions, and provides clear reporting to Compliance leadership. The Manager reports to the Senior Director, who retains responsibility for compliance governance and oversight of significant investigations. The Manager leads assigned audit work, coordinates payer audits, and conducts substantive revenue-cycle patient complaint reviews. The role independently accesses internal data and requests records and explanations for approved reviews, while promptly escalating suspected improper billing, discrepancies, and other compliance concerns. External communications follow delegated approval authority. Operational leaders retain responsibility for order processing, claim submission, collections, routine appeals, service resolution, and corrective-action execution; Finance retains ownership of accounting and ICFR. The role supports Compliance and does not replace independent Internal Audit assurance. During the first year, priorities include mapping order-to-payment risks, assessing high-risk billing workflows, establishing baseline error measures and a documented audit plan, and completing initial priority reviews within the first 90 days. By six months, the Manager is expected to implement consistent workpapers, recurring dashboards, complaint and payer-audit tracking, and corrective-action validation. By year end, the role should demonstrate sustained improvement in targeted controls, reduced repeat findings, and reliable evidence for leadership oversight. Success is measured by audit quality and completion, data reliability, complaint and audit-response timeliness, appropriate escalation, and remediation effectiveness. Work involves confidential records, computer-based analysis, meetings, and staff training. Occasional travel may be required for business needs. Related duties may be assigned as business needs evolve. Koya Medical provides equal employment opportunity and reasonable accommodation in accordance with applicable law.

Requirements

Bachelor’s degree in healthcare administration, accounting, finance, business, or a related field, or equivalent relevant education and experience.
At least five years of experience in healthcare compliance, reimbursement audit, or revenue integrity, including direct Medicare DMEPOS experience.
At least two years independently leading audits, compliance reviews, or cross-functional improvement projects.
Practical knowledge of the DME order-to-payment lifecycle, capped rentals, documentation, authorizations, payer requirements, patient financial protections, and refund and overpayment workflows.
Ability to design and execute an audit from inception through findings, root-cause analysis, and corrective-action validation.
Experience supporting external payer audits and resolving complex compliance issues.
Strong Excel skills, including data reconciliation, lookup functions, pivot tables, and exception analysis.
Ability to produce clear findings reports and concise PowerPoint presentations for leadership.
Sound investigative judgment, discretion, effective cross-functional communication, and ability to coach colleagues while personally performing detailed work.

Nice To Haves

National DME supplier experience.
Medicare patient complaint investigation experience.
Compliance-program development or public-company readiness experience.
CHC, CPMA, or another relevant credential.
Experience with SQL, Power BI, Salesforce, compliance case-management tools, and healthcare billing systems.
Experience supporting payer audits, compliance-program development, or public-company readiness.

Responsibilities

Independently develop and execute risk-based audits, defining objectives, criteria, populations, sampling methods, testing procedures, and evidence standards; maintain reproducible workpapers and supported conclusions.
Review intake, eligibility and benefits verification, coordination of benefits, orders, medical necessity documentation, prior authorization, proof of delivery, and payer requirements; assess handoffs and controls throughout the order lifecycle.
Audit Medicare and commercial billing, payer contract adherence, out-of-network practices, capped rental progression, continued eligibility and use documentation, returns, interruptions, repairs, replacements, and modifiers; review denials, appeals, timely filing, and same-or-similar issues.
Evaluate patient responsibility estimates and communications, QMB protections, balances, collections, Compassionate Care and other financial hardship activity, write-offs, refunds, and potential overpayments; escalate matters requiring repayment assessment or legal review.
Lead compliance investigations of Medicare and commercial patient complaints involving coverage representations, documentation, authorization, delivery, billing, appeals, financial assistance, refunds, and supplier practices; gather evidence, document findings, coordinate resolution, and identify recurring risks.
Coordinate and conduct compliance reviews of Medicare and commercial payer audits; track requests and deadlines, assess documentation quality and response completeness, coordinate approved submissions, analyze findings, and support appeals and corrective actions.
Analyze claims, order, and patient-account data using Excel; reconcile datasets, identify exceptions, maintain reliable dashboards, and explain trends and exposure estimates with appropriate limitations.
Conduct root-cause analysis with operational owners; document corrective actions, responsibilities, and deadlines; independently validate effectiveness; and escalate overdue actions, repeat findings, and significant patient or reimbursement risks.
Prepare concise written findings and management-ready presentations; recommend policy updates and targeted training; and conduct selected additional compliance reviews under the Director’s approved work plan.
Map order-to-payment risks, assess high-risk billing workflows, establish baseline error measures and a documented audit plan, and complete initial priority reviews during the first 90 days.
Implement consistent workpapers, recurring dashboards, complaint and payer-audit tracking, and corrective-action validation by six months.
Demonstrate sustained improvement in targeted controls, reduced repeat findings, and reliable evidence for leadership oversight by year end.
Measure audit quality and completion, data reliability, complaint and audit-response timeliness, appropriate escalation, and remediation effectiveness.