Claims Audit Leader (Remote) – Compliance & QA

Cardinal Health; Olympia (WA); On-site; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

HSA

401k savings plan

Early access to wages

FSAs

Disability coverage

Work-Life resources

Parental leave

Wellness programs

Job summary

Cardinal Health is seeking a Revenue Cycle Management Audit Lead to oversee audit activities and ensure compliance with federal and state regulations. You will manage a team reviewing clinical documentation, compile audit responses, and coordinate with payors to resolve reconciliation issues.

The role requires leadership and project management experience, with a focus on quality assurance and policy enforcement within a large healthcare provider environment.

Qualifications

• Bachelor's degree in related field, or equivalent work experience.
• Leadership, project management, or supervisory experience preferred.
• Urology or wound care product knowledge preferred.

Responsibilities

• Oversee Audit team and respond to audit requests; develop and implement audit processes.
• Focus on quality assurance, quality improvement, and regulatory compliance activities.
• Lead team reviewing clinical documentation accuracy and compile response packets for audits.
• Coordinate with team members to ensure timely completion and maintain high standards.
• Provide monthly feedback on audit or recoupment inquiries, payer-collections issues, and policies.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment audits and respond within required time frames.
• Oversee Recoupment or Refund requests and respond within required time frames.
• Monitor, track, and trend audits in progress and completed ones.
• Gather and review documentation from insurance companies for accuracy and submission approval.
• Maintain communication with CMS and other auditors about issues or concerns.
• Ensure external and internal audits meet legal requirements and company policies.
• Review and timely release of QA-reviews on hold.
• Assist with development of policies and enforcement of compliance.
• Perform extensive account reviews to determine correct payments to providers.
• Review provider contracts/fee schedules for correct payment methodology.
• Prepare reports summarizing findings and recommending corrective action.
• Stay updated on industry standards and Medicare updates for trainings.
• Perform other duties as assigned.

Skills

Leadership

Project management

Supervisory experience

Urology knowledge

Wound care knowledge

Education

Bachelor's degree

Job description

Cardinal Health is seeking a Revenue Cycle Management Audit Lead to oversee audit activities and ensure compliance with federal and state regulations. You will manage a team reviewing clinical documentation, compile audit responses, and coordinate with payors to resolve reconciliation issues.

The role requires leadership and project management experience, with a focus on quality assurance and policy enforcement within a large healthcare provider environment.