Revenue Integrity QC Auditor

Description

Revenue Integrity

Perform advanced revenue cycle auditing and analysis to

support accurate billing, regulatory compliance, and optimal reimbursement

across hospital and professional services claims. As the Revenue Integrity QC

Auditor, you will conduct pre-billing and retrospective claim audits, evaluate

coding, charging, billing, denial, and reimbursement activity, and identify

financial risks, root causes, and revenue recovery opportunities. This role

collaborates with clinical, operational, coding, compliance, information

technology, and revenue cycle partners to strengthen charge capture, claims

performance, billing accuracy, and revenue integrity practices.

In this role, you will:

• 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, compliance risks, and

opportunities for revenue recovery.

• Apply CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding principles and payer

requirements when evaluating government, managed care, and commercial claims.

• Analyze denials, rejections, stop bills, discharged-not-final-billed

accounts, underpayments, and overpayments to identify root causes and recommend

corrective actions.

• Analyze revenue cycle, claims, denial, reimbursement, and operational data

and develop audit findings, reports, dashboards, scorecards, quality control

metrics, and recommendations for leadership.

• Collaborate with Revenue Integrity, Coding, Patient Business Services,

Compliance, Information Technology, and clinical departments to resolve billing

and reimbursement issues and support corrective action plans.

• Provide guidance and education on coding, charging, billing, documentation,

reimbursement requirements, audit processes, and revenue cycle best practices.

• Support process improvement efforts focused on charge integrity, workflow

effectiveness, revenue recovery, compliance, and reduction of revenue loss.

Salary Range:

$88,900 to $190,300 annuallyQualifications

Required

• Bachelor's degree in Health Information Management, Healthcare

Administration, Finance, Business Administration, Accounting, or a related

field, or an equivalent combination of education and experience.

• Eight or more years of progressively responsible experience in healthcare

revenue cycle, revenue integrity, claims auditing, coding, reimbursement

analysis, or related healthcare financial operations.

• Advanced knowledge of healthcare revenue cycle operations, including charge

capture, billing, coding, claims adjudication, denials management, and

reimbursement methodologies.

• Expertise in CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding principles and

their application within healthcare claims auditing.

• Knowledge of Medicare, Medi-Cal, managed care, and commercial payer billing

requirements and reimbursement regulations.

• Advanced analytical skills with the ability to evaluate complex claims,

financial data, reimbursement trends, and operational workflows.

• Ability to identify root causes of billing errors, denials, compliance risks,

and revenue leakage and develop practical solutions.

• Advanced proficiency with healthcare information systems, revenue cycle

applications, reporting tools, data analysis, dashboard development,

spreadsheet applications, and presentation software.

• Strong written and verbal communication skills with the ability to prepare

concise audit reports, findings, and recommendations and explain technical

revenue cycle concepts to diverse audiences.

• Ability to manage multiple projects, competing priorities, and deadlines in a

fast-paced healthcare environment.

• Ability to collaborate effectively with clinical, operational, compliance,

financial, and technical stakeholders.

Preferred

• CCS (Certified Coding Specialist) certification.

• CCS-P (Certified Coding Specialist, Physician-based) certification.

• CPC (Certified Professional Coder) certification.

• CPMA (Certified Professional Medical Auditor) certification.

• CRCR (Certified Revenue Cycle Representative) certification.

• Experience supporting revenue cycle process improvement, workflow redesign,

or revenue recovery initiatives within an academic health system or large

healthcare organization.

• Familiarity with Epic/CareConnect, Clarity, Cirius, and other healthcare

revenue cycle reporting platforms.

UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.