Reimbursement, RCM Quality Auditor (FWD)
About The Position
As an RCM Quality Auditor, a typical day is centered on performing quality audits of pre-billing, billing, and appeal tasks to ensure compliance with standard operating procedures and payer guidelines. The role involves documenting audit findings, tracking quality metrics, and delivering regular QA results to Reimbursement Management while analyzing trends and root causes to recommend corrective actions and process improvements. You will collaborate closely with the RCM Training team to address knowledge gaps, support performance improvement plans as needed, and contribute to the development and maintenance of SOPs and QA documentation. Additional responsibilities include preparing audit reports, providing weekly activity updates, and completing ad hoc audits or projects assigned by management, all in support of consistency, accuracy, and continuous improvement across the revenue cycle.
Requirements
- Five years + of experience in a revenue cycle management role.
- Two years + of experience performing Quality audits in a revenue cycle management environment.
- Proven track record of consistently applying policies and procedures in a healthcare billing environment.
- Extensive knowledge of all tasks within the health insurance billing process.
- Knowledge of healthcare compliance regulations, such as HIPAA, Medicare, Medicaid, and commercial payer guidelines.
- Typing speed of 35 or more words per minute, with 90% or greater accuracy.
Responsibilities
- performing quality audits of pre-billing, billing, and appeal tasks to ensure compliance with standard operating procedures and payer guidelines
- documenting audit findings
- tracking quality metrics
- delivering regular QA results to Reimbursement Management while analyzing trends and root causes to recommend corrective actions and process improvements
- collaborate closely with the RCM Training team to address knowledge gaps
- support performance improvement plans as needed
- contribute to the development and maintenance of SOPs and QA documentation
- preparing audit reports
- providing weekly activity updates
- completing ad hoc audits or projects assigned by management
Benefits
- Excellent Annual Salary + 20% Bonus Potential
- 20 Accrued PTO Days Annually
- 10 Paid Holidays
- 401K with 100% Company Match up to 6%
- 3 Health Care Plan Options + Company HSA Contribution
- Company Stock Grant Upon Hire
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
501-1,000 employees
