RCM Auditor

• Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: 
  • Charge entry and charge capture accuracy 
  • CPT, HCPCS, and ICD-10 coding compliance 
  • Modifier usage 
  • Workers’ compensation billing rules and state-specific fee schedules 
  • Claim submission accuracy and clean claim rates 
  • Payment posting and adjustment accuracy 
  • AR follow-up effectiveness and denial resolution workflows 
• Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance 
• Denial & Revenue leakage analysis: 
  • Analyze denial trends across WC, Medicare, and commercial payers 
  • Identify root causes of denials and recommend corrective actions 
  • Quantify revenue impact from: 
  • Coding errors 
  • Missed charges 
  • Underpayments 
  • Inefficient workflows 

• Ensure adherence to: 
  • CMS guidelines and Medicare billing requirements 
  • NCCI (CCI edits) and payer-specific edits 
  • State Workers’ Compensation regulations 
  • Documentation standards for pain management procedures 
  • Support internal and external audit readiness (RAC, MAC, payer audits). 
• Reporting & KPI development through audit dashboard 
• Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements 
• Partner with all BHC teams to develop and deliver targeted education based on audit findings. 
• Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency 
• Establish and maintain quality assurance programs across RCM functions 
• Perform routine QA reviews of staff productivity and accuracy 
• Recommend automation opportunities and system enhancements 
• Assumes other responsibilities as appropriate to the position and organizational needs

• High school diploma or equivalent required; Associate degree preferred 
• Active coding certification required: CPC, CCS, or equivalent (AAPC or AHIMA) 
• 5+ years of experience in revenue cycle management  
• 3+ years of auditing experience within healthcare billing or coding 
• Strong experience in pain management 
• Experience with Medicare and commercial payer guidelines 
• Ability to work in a fast-paced environment, meet daily deadlines, and collaborate with cross-functional RCM teams 
• Excellent communication skills with ability to present findings to providers and RCM leadership 
• Advanced understanding of NCCI edits and payer-specific billing guidelines 
• Accuracy and attention to detail, analytical thinking and problem solving and high integrity and compliance focus 
• Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications 

Why You'll Love Working Here: 

• Amazing work/life balance
• Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO) 
• 401(K) Plan with Employer Matching 
• License & Tuition Reimbursements
• Paid Time Off
• Holiday Pay & Floating Holiday
• Employee Perks and Discount Programs
• Supportive environment to help you grow and succeed

Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC. 

Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us.