At Sciometrix, our goal is to deliver the best-ever personalized care with utmost compassion, enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value-Based Care, and Population Health. We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes.
Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services. At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well-being and provider efficiency. With Sciometrix, the future of healthcare is not just about treating illnesses—it’s about empowering patients to live their best lives.
Innovative Healthcare Environment: Be part of a fast-growing digital health organization working at the intersection of healthcare compliance, care management, and technology-driven solutions.
Meaningful Impact: Play a critical role in ensuring accurate and compliant billing for CCM and RPM programs that directly support patient care and provider sustainability.
Collaborative Culture: Work closely with clinical, operational, and compliance teams in a transparent and supportive work environment.
Competitive Compensation: Attractive salary aligned with your experience and expertise.
Commitment to Diversity: We are dedicated to fostering diversity, inclusion, and belonging across all levels of the organization.
Global Exposure: Collaborate with cross-functional teams supporting U.S. healthcare programs from a global delivery model.
Positive Work Environment: Join a people-first organization where compliance excellence and professional growth are valued and recognized.
We are seeking a Prebill Analyst – CCM & RPM Programs to join our Pre-Bill Audit (RCM) team. The ideal candidate will be responsible for ensuring the accuracy, compliance, and integrity of claims submitted under Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs. This role requires strong knowledge of U.S. healthcare regulations, CMS billing guidelines, and hands-on experience auditing medical claims and clinical documentation.
· Conduct routine and targeted pre-bill audits for CCM and RPM claims.
· Verify clinical documentation and billing accuracy in accordance with CMS guidelines and U.S. healthcare compliance standards.
· Identify billing errors, documentation gaps, inconsistencies, or potential compliance risks and recommend corrective actions.
· Collaborate with clinical, operational, and RCM teams to ensure documentation appropriately supports billed services.
· Track audit findings, analyze trends, and prepare detailed audit reports for leadership review.
· Support continuous quality improvement initiatives by sharing insights and best practices.
· Stay up to date with changes in CMS regulations, payer policies, and compliance requirements related to CCM and RPM.
· Participate in internal compliance training and audit readiness initiatives.
· Provide feedback, guidance, and training to relevant teams to address recurring audit findings.
Bachelor’s degree in any discipline.
Minimum 2+ years of experience in healthcare claims auditing, preferably involving CCM and RPM services.
Strong understanding of U.S. healthcare systems, CMS billing guidelines, HIPAA, and regulatory compliance standards.
Experience working within RCM workflows and pre-bill audit processes.
High attention to detail with strong analytical and problem-solving skills.
Excellent written and verbal communication skills.
Ability to work independently in a remote environment while collaborating with cross-functional teams.
Experience supporting U.S. healthcare clients from offshore delivery (India) is a plus.
Location: Remote (India)
Shift Timing: 8:00 AM – 5:00 PM EST
Sciometrix is an Equal Opportunity Employer and is proud to offer equal employment opportunity to everyone regardless of race, color, ancestry, religion, gender, national origin, sexual orientation, age, citizenship, disability, gender identity, veteran status, and more.
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