Revenue Cycle Compliance Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Revenue Cycle Compliance Auditor (Remote) based in the United States. The Revenue Cycle Compliance Auditor plays a vital role in strengthening healthcare compliance, billing accuracy, and risk management across clinical and hospital services. In this role, you will independently conduct comprehensive audits of medical records, coding practices, billing activities, and clinical documentation to ensure alignment with regulatory requirements and organizational policies. You will identify compliance risks, investigate revenue cycle issues, and translate audit findings into actionable recommendations that improve operational performance and financial accuracy. Working closely with coding professionals, billing teams, physicians, and compliance leadership, you will also deliver targeted education to promote consistent documentation and coding standards. This opportunity is ideal for a detail-oriented healthcare compliance professional who combines technical coding expertise with analytical thinking, clear communication, and a commitment to continuous improvement. Accountabilities - Revenue Cycle Compliance Audits: Conduct independent, comprehensive reviews of healthcare records and billing activities to assess accuracy, medical necessity, compliance risks, charge capture, and adherence to applicable coding and documentation guidelines. - Coding and Documentation Review: Evaluate inpatient, outpatient, clinic, rural healthcare, and professional fee encounters, as applicable, using CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding guidelines to ensure billed services are supported by clinical documentation. - Risk Assessment and Investigations: Conduct revenue cycle investigations, analyze denials and charge trends, identify compliance gaps, and assess potential financial and operational risks. - Audit Reporting and Recommendations: Prepare detailed written audit reports summarizing findings, quantifying potential impact, highlighting educational opportunities, and recommending corrective actions and improvement plans.

- Audit Tools and Methodologies: Use auditing platforms and risk-based data to conduct coding reviews, denial audits, and other targeted departmental audits. Contribute to the development and refinement of audit methods, workflows, and tools. - Education and Training: Develop and deliver training based on audit findings to coders, billers, physicians, and other relevant stakeholders, focusing on clinical documentation, coding accuracy, service selection, charge capture, and timely claim submission. - Compliance Program Support: Assist Corporate Compliance in maintaining the organization's compliance program and contribute to annual risk assessments and audit work plan development. - Process Improvement: Identify opportunities to improve healthcare data accuracy, compliance practices, departmental efficiency, and the effectiveness of revenue cycle processes. - Cross-Functional Collaboration: Partner with hospital teams, surgical and clinical practices, department colleagues, and leadership to address audit findings and strengthen revenue cycle compliance. - Professional Standards and Additional Duties: Follow departmental and professional standards, participate in internal initiatives and process improvement projects, and perform other related duties as assigned. Requirements - Education: Associate's degree or technical degree, or an equivalent combination of education and relevant experience, is required. A bachelor's degree is preferred. - Healthcare Coding Experience: At least five years of experience in healthcare coding across inpatient, outpatient, rural healthcare, and/or professional fee services is required. - Auditing Experience: Three or more years of experience auditing clinic and/or facility revenue cycle processes is preferred.