Quality Assurance (QA) & Billing Compliance Auditor →

Rcmbilling; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

Rcmbilling is seeking a Quality Assurance (QA) & Billing Compliance Auditor to audit claims before submission and after payment, review coding accuracy, find lost revenue, and ensure compliance with federal, state and payer rules.

You will perform random and targeted audits of submitted claims, codes, and denial appeals, audit CPT/ICD-10/modifier usage against clinical notes, and prepare comprehensive reports highlighting recurring errors and training opportunities for compliance improvements.

Qualifications

• 4+ years in RCM quality auditing, medical record review, or compliance.
• Certified Medical Coder preferred (CPC/CPMA/CCS).
• In-depth knowledge of OIG Work Plan, False Claims Act, HIPAA privacy/security rules, and NCCI edits.
• Experience conducting double-blind audits and root cause investigations.

Responsibilities

• Audit random and targeted audits of submitted claims, coded encounters, and denial appeals.
• Audit CPT, ICD-10, and modifier applications against clinical notes for accuracy.
• Measure biller and coder accuracy percentages against quality benchmarks.
• Prepare comprehensive audit reports highlighting recurring errors, compliance vulnerabilities, and training opportunities.

Skills

RCM quality auditing

Medical records review

Compliance

Auditing

Education

CPC/CPMA/CCS Certification

Job description

Quality Assurance (QA) & Billing Compliance Auditor

• Full-Time

About the role

Audit claims before submission and after payment, review coding accuracy, find lost revenue, and check compliance with federal, state and payer rules.

What you will do

• Perform random and targeted audits of submitted claims, coded encounters, and denial appeals.
• Audit accuracy of CPT, ICD-10, and modifier applications against clinical notes.
• Measure biller and coder accuracy percentages against quality benchmarks.
• Prepare comprehensive audit reports highlighting recurring errors, compliance vulnerabilities, and training opportunities.

What we are looking for

• 4+ years in RCM quality auditing, medical record review, or compliance.
• Certified Medical Coder (CPC, CPMA, or CCS) strongly preferred.
• In-depth knowledge of OIG Work Plan, False Claims Act, HIPAA privacy/security rules, and NCCI edits.
• Experience conducting double-blind audits and root cause investigations.

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