Revenue Cycle Auditor - TMCOne - Remote

Tucson Medical Center; Tucson (AZ); Remote; USD 60,000 - 90,000; Full time

Job summary

A leading healthcare institution is looking for a Revenue Cycle Auditor to manage pre- and post-payment claim audits to ensure compliance with billing policies. The role involves collaboration with various departments to resolve issues and educate clinical staff on audit outcomes. Candidates should have a strong revenue cycle background and relevant certifications.

Qualifications

• At least three years in a hospital or physician setting with extensive Revenue Cycle knowledge.
• Minimum two years of audit experience, especially in High Balance, Cost Outlier, or facility-based clinic audits.

Responsibilities

• Conducts pre- and post-payment claim auditing of medical records.
• Assists with billing issues and denials.
• Develops policies supporting organizational goals.

Skills

Knowledge of ICD and CPT coding practices

Proficiency with Microsoft Office

Analytical skills

Education

Completion of a two-year college preferred

Job description

Revenue Cycle Auditor - TMCOne - Remote

Job CategoryClerical

ScheduleFull time

Shift1 - Day Shift

SUMMARY:

The Revenue Cycle Auditor is responsible for pre- and post-payment claim auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position also assists Revenue Cycle Services, HIM, and other departments with resolving billing issues and/or denials requiring clinical expertise, participates in external audit requests, and handles special projects as needed. Additionally, the Revenue Cycle Auditor serves as an audit outcome educator with clinical staff in clinic and department settings. We are seeking a coding auditor to audit our coders and providers. CPC required, CPMA preferred. This is a remote position.

ESSENTIAL FUNCTIONS:

• Provides pre- and post-payment claim auditing of medical records and associated clinical documentation.
• Assists Revenue Cycle Services, HIM, and other departments with billing issues and denials.
• Develops policies and procedures supporting organizational goals.
• Monitors industry trends for organizational impact.
• Provides guidance and leadership related to revenue benefits and audit findings.
• Prepares detailed performance reports for management.
• Ensures compliance with state and federal benefits legislation and submits regulatory reports.
• Develops contingency plans for unforeseen circumstances.
• Manages staff recruitment, training, performance evaluation, and delegation.
• Serves as an audit outcome educator with clinical staff.
• Adheres to safety, confidentiality, and organizational policies.
• Performs related duties as assigned.

Coding-specific duties:

• Conducts chart audits on coders and provides education on compliance.
• Analyzes provider claims data to identify audit risks.
• Performs provider coding audits and educates providers on findings.
• Serves as a resource for coding guidelines and payer policies.

MINIMUM QUALIFICATIONS

• Education: Completion of a two-year college preferred or equivalent experience.
• Experience: At least three years in hospital or physician setting with extensive Revenue Cycle knowledge; minimum two years of audit experience, especially in High Balance, Cost Outlier, or facility-based clinic audits.

LICENSES OR CERTIFICATIONS

• Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

• Thorough knowledge of ICD and CPT coding practices and tools.
• Proficiency with Microsoft Office.
• Skill in developing procedures and training materials.
• Knowledge of HIM, billing, Charge Description Master, denials management, and financial analysis.
• Ability to evaluate coding performance and recommend improvements.
• Ability to interpret medical documents, contracts, and legislation.
• Ability to analyze data and present reports to management.