Revenue Integrity Auditor: Elevate Billing & Reimbursement

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

Job summary

University of California - Los Angeles Health seeks an experienced Revenue Integrity QC Auditor to perform advanced audits across hospital and professional claims, ensuring compliant coding, charge capture, and reimbursement. This role collaborates with clinical, operational, coding, compliance, and IT teams to strengthen revenue integrity practices and risk management.

The perfect candidate has 8+ years in healthcare revenue cycle and expert CPT/ICD-10 coding knowledge, with strong analytical

Qualifications

• Bachelor's degree or equivalent education/experience in health information management, healthcare administration, finance or related field.
• Eight+ years of progressive experience in healthcare revenue cycle, revenue integrity, claims auditing, coding, or related 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, ICD-10-PCS coding principles and applications in claims auditing.
• Knowledge of Medicare, Medi-Cal, managed care, and commercial payer requirements and regulations.
• Analytical skills to evaluate complex claims, financial data, and reimbursement trends.
• Ability to identify root causes of errors and development of corrective actions.
• Proficiency with healthcare information systems, data analysis, reporting tools, dashboards and Excel.

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, and compliance risks.
• Apply CPT/HCPCS/ICD-10 coding principles and payer requirements when evaluating government, managed care, and commercial claims.
• Analyze denials, rejections, stop bills, underpayments and overpayments to identify root causes and recommend corrective actions.
• Develop audit findings, reports, dashboards, scorecards, and quality metrics for leadership.
• Collaborate with Revenue Integrity, Coding, Patient Business Services, Compliance and IT to resolve issues and support corrective action plans.
• Provide guidance and education on coding, documentation, and reimbursement requirements.
• Support process improvements focused on charge integrity, workflow effectiveness, revenue recovery, and compliance.

Skills

Healthcare revenue cycle

Audit & compliance

Data analysis

Charge capture and denial management

Communication

Dashboard/reporting

Education

Bachelor's degree in Health Information Management or related field

Tools

Epic/CareConnect

Clarity

Excel

Job description

University of California - Los Angeles Health seeks an experienced Revenue Integrity QC Auditor to perform advanced audits across hospital and professional claims, ensuring compliant coding, charge capture, and reimbursement. This role collaborates with clinical, operational, coding, compliance, and IT teams to strengthen revenue integrity practices and risk management.

The perfect candidate has 8+ years in healthcare revenue cycle and expert CPT/ICD-10 coding knowledge, with strong analytical