Revenue Integrity Auditor: Coding & Compliance Expert

University of California - Irvine Health; Irvine (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

UCI Health is seeking a Revenue Cycle Audit Specialist to evaluate internal controls, coding accuracy, and denial trends across hospital and professional billing. The role emphasizes identifying regulatory and compliance risks and implementing corrective measures to improve gross and net revenue.

Applicants should hold current coding certifications (CPC, COC, or AHIMA equivalent) and have five years of hospital billing and auditing experience, with strong Excel skills and knowledge of CMS payer

Qualifications

• Proficient EXCEL, WORD, PowerPoint skills.
• Must possess multiple current Coding Certifications (i.e., CPC, COC, or AHIMA equivalent).
• Must possess experience reviewing and interpreting CMS, Commercial and Government payer coding and payment requirements.
• Must possess a current Coding Certification (CPC, COC, or AHIMA equivalent).
• Must demonstrate customer service skills appropriate to the job.
• Knowledge of health information systems for computer application to medical records.
• Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate DRG.
• Knowledge of DRG/APC reimbursement.
• Five years' experience in hospital and physician billing, charging practices.
• Five years' auditing experience working in acute care hospital and academic institution.

Responsibilities

• Perform Revenue Cycle audit reviews to identify regulatory and compliance risk.
• Evaluate internal and operational controls for compliance with hospital and professional billing standards.
• Prepare comprehensive audit reports quantifying impacts on gross and net revenue.
• Identify opportunities for educational initiatives and corrective actions.

Skills

Excel

Word

PowerPoint

Coding Certifications

CMS knowledge

Auditing

Communication

Hospital billing

Tools

Epic EMR

Audit software

Job description

UCI Health is seeking a Revenue Cycle Audit Specialist to evaluate internal controls, coding accuracy, and denial trends across hospital and professional billing. The role emphasizes identifying regulatory and compliance risks and implementing corrective measures to improve gross and net revenue.

Applicants should hold current coding certifications (CPC, COC, or AHIMA equivalent) and have five years of hospital billing and auditing experience, with strong Excel skills and knowledge of CMS payer