Revenue Cycle Compliance Auditor-FT-Business Office-Provo

Revere Health; Provo (UT); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Revere Health is seeking a Revenue Cycle Compliance Auditor to review clinical documentation and coding, ensuring services are billed accurately and in compliance with payer and regulatory requirements. This education-driven role collaborates with our internal compliance team to reduce billing risk across the organization.

You will identify patterns of risk, communicate actionable solutions to providers and staff, and lead provider education based on audit findings while supporting payer audits

Qualifications

• 5+ years professional coding experience required.
• CPC or CCS certification required; CPMA encouraged.
• Experience performing coding or compliance audits.
• Advanced knowledge of CPT, ICD-10-CM, HCPCS, modifiers and payer policies.

Responsibilities

• Conduits pre-bill and post-bill compliance audits across specialties and payers.
• Reviews E/M leveling, procedure coding, modifiers, and medical necessity.
• Interprets medical records and applies coding guidelines consistently.
• Performs HCC coding review for Value Based Care initiatives.
• Researches current industry standards and payer policies.
• Documents findings clearly and defensibly.
• Identifies patterns of risk by provider, specialty, and service-line.
• Supports payer audits, refund requests, and internal investigations.
• Leads provider and staff education based on audit findings.

Skills

Coding audits

Regulatory compliance

Education

CPC

CCS

CPMA

Job description

Position Summary

We're seeking a Revenue Cycle Compliance Auditor who will perform thorough reviews of clinical documentation and coding to ensure services are billed accurately in compliance with payer and regulatory requirements. We welcome detail-oriented applicants who will work in collaboration with our internal compliance team to reduce systemic billing risk across our organization.

This role is largely education driven with an aim to identify trends and communicate meaningful solutions to our providers, administrators, staff, and payer partners.

Essential Job Functions

• Conducts pre-bill and post-bill compliance audits across specialties and payers.
• Reviews E/M leveling, procedure coding, modifiers, and medical necessity.
• Interprets medical records and applies coding guidelines consistently across all billing aspects.
• Performs HCC coding review to assist with Value Based Care initiatives.
• Researches current industry standards by way of federal guidelines, payer policies, and creditable coding sources.
• Documents findings in a clear and defensible manner.
• Identifies patterns of risk by provider, specialty, and service-line.
• Supports payer audits, refund requests, and internal investigations.
• Leads provider and staff education based on audit findings.

Qualifications

• 5 or more years of professional coding experience required--specialty medicine experience preferred
• CPC or CCS required--specialty certifications a plus; CPMA optional but encouraged
• Prior experience performing coding or compliance audits
• Advanced knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and payer policies

Hours

Hours: Monday - Friday 8am to 5pm; Hybrid Position