RCM Auditor

Integrated Pain Management Medical Group, Inc.•Walnut Creek, CA

2d•$28 - $33•Remote

About The Position

The Revenue Cycle Management 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.

Requirements

High school diploma or equivalent required
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

Nice To Haves

Associate degree preferred

Responsibilities

Perform 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, and AR follow-up effectiveness and denial resolution workflows.
Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance.
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, and inefficient workflows.
Ensure adherence to CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, state Workers’ Compensation regulations, and documentation standards for pain management procedures.
Support internal and external audit readiness (RAC, MAC, payer audits).
Develop and maintain an audit dashboard for reporting and KPI development.
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.
Assume other responsibilities as appropriate to the position and organizational needs.