Senior Revenue Integrity Auditor: Claims & Compliance

Morehouse School of Medicine; Atlanta (GA); On-site; USD 90,000 - 135,000; Full time

Job summary

Morehouse School of Medicine is seeking a Sr. Claims Auditor - Revenue Integrity to conduct comprehensive retrospective and concurrent audits of professional and facility medical claims, ensuring coding accuracy, billing compliance, and proper reimbursement.

This role collaborates across Revenue Integrity, Compliance, and clinical departments to minimize risk. The ideal candidate has 7+ years of healthcare coding audit experience, extensive CPT/HCPCS/ICD-10-CM knowledge, and familiarity with

Qualifications

• Minimum of 7 years of professional coding audit experience in a healthcare system, academic medical center, medical university, faculty practice plan, or integrated health system.
• Experience in Revenue Integrity including charge capture validation, claims auditing, denial management, reimbursement analysis, compliance reviews, and revenue cycle optimization.
• Extensive knowledge of CPT, HCPCS, ICD-10-CM, medical necessity requirements, payer reimbursement methodologies, and regulatory guidelines.
• Experience auditing provider documentation and billing practices across multiple specialties within a teaching hospital, physician practice, or academic health system.
• Strong understanding of Medicare Physician Fee Schedule, APC, DRG, payer contracts, and reimbursement methodologies affecting professional and facility claims.
• Experience identifying revenue leakage, compliance vulnerabilities, and process improvement opportunities within complex healthcare organizations.

Responsibilities

• Audit professional and facility claims for coding accuracy, billing compliance, reimbursement integrity, and regulatory adherence.
• Evaluate claims throughout the revenue cycle to identify opportunities for revenue enhancement, charge capture optimization, denial prevention, and reimbursement accuracy.
• Review documentation, coding, charge capture processes, and billing practices to validate medical necessity and regulatory compliance.
• Perform detailed analyses of claim edits, denials, underpayments, overpayments, and reimbursement variances to identify root causes and recommend corrective actions.
• Monitor compliance with CMS, Medicare, Medicaid, commercial payer, OIG, and other applicable regulatory requirements.
• Collaborate with Revenue Integrity, Compliance, Patient Financial Services, Clinical Departments, and Coding Leadership to improve revenue cycle performance and minimize organizational risk.
• Identify trends that may impact reimbursement, financial performance, or regulatory compliance and communicate findings to leadership through detailed audit reports and presentations.
• Assist in developing and implementing training that improves charge capture accuracy, documentation quality, coding compliance, and reimbursement outcomes.
• Support internal and external audit activities, including payer audits.
• Conduct focused audits related to Evaluation and Management (E/M) services, procedural coding, assist with teaching physician documentation, modifier utilization, clinical documentation integrity, and specialty-specific billing requirements.

Skills

Revenue Integrity

Claims Auditing

Charge Capture

Regulatory Compliance

Medical Coding

Denials Analysis

Education

CPC/CPMA/CCS/RHIA/RHIT/CRC Certification

CPMA Certification preferred

AMC/Teaching Hospital experience preferred

Job description

Morehouse School of Medicine is seeking a Sr. Claims Auditor - Revenue Integrity to conduct comprehensive retrospective and concurrent audits of professional and facility medical claims, ensuring coding accuracy, billing compliance, and proper reimbursement.

This role collaborates across Revenue Integrity, Compliance, and clinical departments to minimize risk. The ideal candidate has 7+ years of healthcare coding audit experience, extensive CPT/HCPCS/ICD-10-CM knowledge, and familiarity with