Revenue Integrity Auditor: Claims & Reimbursement Expert

UCLA Health; Los Angeles (CA); On-site; USD 89,000 - 190,000; Full time

Job summary

UCLA Health in Los Angeles seeks a Revenue Integrity QC Auditor to perform advanced revenue cycle auditing and analysis, supporting accurate billing and regulatory compliance across hospital and professional services claims.

You will conduct pre-billing and retrospective audits, evaluate coding and charging, identify financial risks, and collaborate with clinical, operational, and IT teams to strengthen charge capture and revenue integrity practices.

Qualifications

• Bachelor’s degree or equivalent in a related field.
• Eight or more years of progressively responsible experience in healthcare revenue cycle, revenue integrity, claims auditing, coding, reimbursement analysis, or related healthcare financial operations.
• Advanced knowledge of revenue cycle operations including charge capture, billing, coding, claims adjudication, denials management, and reimbursement methodologies.
• Expertise in CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding principles and their application within healthcare claims.
• Knowledge of Medicare, Medi-Cal, managed care, and commercial payer billing requirements and reimbursement regulations.
• Advanced analytical skills with the ability to evaluate complex claims, financial data, reimbursement trends, and operational workflows.
• Identify root causes of billing errors, denials, compliance risks, and revenue leakage and develop practical solutions.
• Advanced proficiency with healthcare information systems, revenue cycle applications, reporting tools, data analysis, dashboard development, spreadsheet applications, and presentation software.
• Strong written and verbal communication skills with the ability to prepare concise audit reports, findings, and recommendations and explain technical revenue cycle concepts to diverse audiences.
• Ability to manage multiple projects, competing priorities, and deadlines in a fast-paced healthcare environment.
• Ability to collaborate effectively with clinical, operational, compliance, financial, and technical stakeholders.

Responsibilities

• Conduct pre-billing, concurrent, and retrospective audits of hospital and professional claims to evaluate coding, charging, billing, reimbursement accuracy, and regulatory compliance.
• Review claims and medical record documentation to identify billing errors, charge discrepancies, payment variances, denials, compliance risks, and opportunities for revenue recovery.
• Apply CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding principles and payer requirements when evaluating government, managed care, and commercial claims.
• Analyze denials, rejections, stop bills, discharged-not-final-billed accounts, underpayments, and overpayments to identify root causes and recommend corrective actions.
• Analyze revenue cycle, claims, denial, reimbursement, and operational data and develop audit findings, reports, dashboards, scorecards, quality control metrics, and recommendations for leadership.
• Collaborate with Revenue Integrity, Coding, Patient Business Services, Compliance, Information Technology, and clinical departments to resolve billing and reimbursement issues and support corrective action plans.
• Provide guidance and education on coding, charging, billing, documentation, reimbursement requirements, audit processes, and revenue cycle best practices.
• Support process improvement efforts focused on charge integrity, workflow effectiveness, revenue recovery, compliance, and reduction of revenue loss.

Skills

Revenue integrity

Auditing

Analytics

Communication

Collaboration

Education

Bachelor’s degree (Health Information Management / Healthcare Administration / Finance / Business Administration / Accounting)

Tools

Epic/CareConnect

Clarity

Cirius

Job description

UCLA Health in Los Angeles seeks a Revenue Integrity QC Auditor to perform advanced revenue cycle auditing and analysis, supporting accurate billing and regulatory compliance across hospital and professional services claims.

You will conduct pre-billing and retrospective audits, evaluate coding and charging, identify financial risks, and collaborate with clinical, operational, and IT teams to strengthen charge capture and revenue integrity practices.