Sr. Claims Auditor - Revenue Integrity

Morehouse School of Medicine

Atlanta (GA)

On-site

USD 90,000 - 135,000

Full time

38 hours ago

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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

Position Information

About MSM

Morehouse School of Medicine (MSM) is a place of distinction, serving as the nation’s leading academic medical center for vulnerable populations. It’s also a place for passionate individuals looking to join a dedicated community working today to help prepare tomorrow’s leaders.

We exist to:
Improve the health and well-being of individuals and communities;
Increase the diversity of the health professional and scientific workforce;
Address primary health care through programs in education, research and service;
With emphasis on people of color and the under-served urban and rural populations in Georgia, the nation and the world.

At Morehouse School of Medicine, we’re leading the creation and advancement of health equity. You will find a fulfilling career at MSM !

Posting Number

NONAC3798

Job Title

Sr. Claims Auditor - Revenue Integrity

Position Title

Sr. Claims Auditor - Revenue Integrity

Position Type

Non-Faculty

Number of vacancies

Department

Compliance

Position Summary

Revenue Integrity and Claims Audit Responsibilities

Conduct comprehensive retrospective and concurrent audits of professional and facility medical claims to ensure coding accuracy, billing compliance, reimbursement integrity, and adherence to federal, state, payer, and institutional requirements.
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, regulatory compliance, and appropriate reimbursement.
Perform detailed analyses of claim edits, denials, underpayments, overpayments, and reimbursement variances to identify root causes and recommend corrective action plans.
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 improve 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 common within an academic medical center environment.
Revenue Integrity Expertise
Claims Auditing and Reimbursement Validation
Regulatory Compliance
Professional Fee Coding
Revenue Cycle Operations
Medical Necessity Review
Denials and Appeals Analysis
Risk Assessment and Mitigation
Charge Capture Optimization
Data Analytics and Reporting
Academic Medical Center Billing Practices

Minimum Qualifications

Required Experience

Minimum of 7 years of professional coding audit experience within a healthcare system, academic medical center, medical university, faculty practice plan, or integrated health system.
Demonstrated 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.

Preferred Qualifications

Certification as CPC , CPMA , CCS , RHIA , RHIT , CRC , or equivalent credential required.
Certified Professional Medical Auditor ( CPMA ) strongly preferred.
Experience working in an Academic Medical Center ( AMC ), Medical University, Faculty Group Practice, or Teaching Hospital environment strongly preferred.
Knowledge of teaching physician regulations, resident documentation requirements, split/shared visits, and academic practice billing compliance preferred.
Proven ability to analyze large volumes of claims and financial data to identify revenue integrity opportunities and compliance risks.

Closing Date

12/17/2026

Special Instructions to Applicants

Employment in this role may be contingent upon extramural funding and successful performance and may be terminated or reduced in percentage of appointment if such funding is not secured or ceases to be available.

Morehouse School of Medicine is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all Federal and Georgia State laws, regulations, and executive orders regarding non-discrimination and affirmative action. Morehouse School of Medicine does not discriminate on the basis of race, age, color, religion, national origin or ancestry, sex, gender, disability, veteran status, genetic information, sexual orientation, or gender identity or expression.

Pre-Employment/Employment Requirements

All offers of employment are contingent upon successful completion of all pre-employment screenings.

Immunization

Immunization Requirements

It is MSM’s Immunization policy that all Prospective Employees are encouraged to provide proof that they are vaccinated against COVID -19 prior to commencement of employment. If employment will commence during Flu Season, MSM requires all individuals to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless granted an exemption. Failure to provide proof of vaccination for any required vaccines or obtain an exemption from MSM will result in rescission of a candidate’s offer of employment or disciplinary action up to and including termination.

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