Remote Claims Audit Lead, Revenue Cycle

Cardinal Health; Santa Fe (NM); Remote; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k savings plan

Paid time off

HSA

Job summary

Cardinal Health is seeking an experienced professional to oversee the Audit team within Revenue Cycle Management. You will respond to audit requests, develop audit processes, and ensure compliance with federal and state regulations.

You will lead the review of clinical documentation, compile response packets for audits, and collaborate with colleagues to meet high standards. The role includes monitoring audits, managing recoupments, and ensuring timely communications with payors.

Qualifications

• 4–8 years of experience preferred.
• Bachelor's degree in related field or equivalent work experience preferred.
• Leadership, project management or supervisory experience preferred.
• Urology or wound care product knowledge preferred.

Responsibilities

• Oversee the Audit team and respond to all audit requests in a timely manner; develop and implement audit processes.
• Focus on quality assurance, quality improvement, and compliance initiatives per Federal and State regulations.
• Lead team reviewing validity of clinical documentation for accuracy and prepare response packets for audits.
• Collaborate with team members to complete tasks to the highest standards.
• Provide monthly feedback on successes and failures related to audit or recoupment inquiries and policy compliance.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit and respond within required time frames.
• Oversee all Recoupment or Refund requests and respond within required time frames.
• Monitor, track, and trend audits in progress and completed.
• Gather and review documentation for audits and approvals from insurers for accuracy.

Skills

Audit coordination

Quality assurance

Regulatory compliance

Leadership

Project management

Supervisory experience

Industry knowledge (RCM)

Education

Bachelor's degree or equivalent

Job description

Cardinal Health is seeking an experienced professional to oversee the Audit team within Revenue Cycle Management. You will respond to audit requests, develop audit processes, and ensure compliance with federal and state regulations.

You will lead the review of clinical documentation, compile response packets for audits, and collaborate with colleagues to meet high standards. The role includes monitoring audits, managing recoupments, and ensuring timely communications with payors.