Remote Claims Audit Lead, Revenue Cycle Management

Cardinal Health; Columbia (SC); On-site; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off plan

Health savings account (HSA)

401k savings plan

Access to wages before pay day with my

Flexible spending accounts (FSAs)

Disability coverage (short/long-term)

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Job summary

Cardinal Health is seeking an Audit and Compliance-focused professional to lead the audit team within Revenue Cycle Management. You will ensure accurate clinical documentation, timely responses to audits, and robust QA measures while supporting policy enforcement and continuous improvement.

The role requires 4–8 years of experience, a related bachelor’s degree, and knowledge of Medicare updates. Strong leadership and collaboration across teams are essential to succeed in this fast-paced

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 received in a timely manner, and develop and implement audit processes.
• Focus on quality assurance, quality improvement, and compliance with Federal and State regulations.
• Lead the team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for audits.
• Collaborate with team members to ensure all tasks are completed on time and to high standards.
• Provide monthly feedback on audit successes and failures and cover areas related to audits, recoupment inquiries, payor collections inconsistencies, and policies/procedures.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit and respond within required time frames.
• Oversee all aspects of Recoupment or Refund requests and respond within required time frames.
• Monitor, track, and trend all current, in progress, and completed audits.
• Gather and review documentation for audits, recoupments, or other requests from insurance companies for accuracy and submission approval.
• Ensure communication with CMS and other auditors about issues or concerns.
• Ensure audits meet legal requirements and company policies.
• Review and timely release of claims marked for QA Review on hold.
• Assist with development of company policies and enforcing compliance.
• Perform extensive reviews of accounts to determine correct payments to providers.
• Review provider contracts/fee schedules to determine correct payment methodologies.
• Prepare reports summarizing findings and recommending corrective action.
• Stay up to date on industry standards and regulations and train on Medicare updates.

Skills

Leadership

Project management

Supervisory experience

Education

Bachelor's degree in related field

Job description

Cardinal Health is seeking an Audit and Compliance-focused professional to lead the audit team within Revenue Cycle Management. You will ensure accurate clinical documentation, timely responses to audits, and robust QA measures while supporting policy enforcement and continuous improvement.

The role requires 4–8 years of experience, a related bachelor’s degree, and knowledge of Medicare updates. Strong leadership and collaboration across teams are essential to succeed in this fast-paced