Revenue Cycle Integrity Auditor

Position Summary:

We are seeking a highly analytical and detail-oriented Revenue Cycle Integrity Auditor to join our Urgent Care administrative team in Youngstown, OH. This role is instrumental in ensuring accurate billing and coding, regulatory compliance, and optimal reimbursement across the revenue cycle. The successful candidate will possess strong knowledge of medical necessity standards, coding guidelines, and payer-specific regulations—while also supporting audit preparedness, staff education, and process improvement.

Key Responsibilities:

• Conduct comprehensive audits of medical records to ensure coding accuracy, medical necessity, compliance with payer guidelines, and alignment with CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding standards.
• Review and analyze denials, charge trends, and billing compliance risks to identify patterns and opportunities for corrective action.
• Evaluate encounters across clinic visit settings, ensuring documentation supports services rendered and billed.
• Prepare detailed audit reports outlining findings, quantifiable impact, root causes, and recommended actions for improvement.
• Collaborate with billing/coding, operations, and clinical teams to clarify documentation requirements and promote correct charge capture.
• Coordinate and support responses to external audits and Attorney-Client Privilege audits, including appeals preparation and deadline tracking.
• Track and trend audit results, denials, and risk indicators to inform training, mitigate financial exposure, and enhance compliance.
• Lead or participate in multidisciplinary workgroups or quality improvement initiatives and serve as a project lead when needed.
• Mentor and provide on-the-job training to coding and billing staff based on audit outcomes and regulatory updates.
• Participate in the development of internal audit plans, risk assessments, and continuous improvement of audit tools and methodologies.
• Interpret and reference applicable federal/state regulations and payer communications to support compliance and audit integrity.
• Perform additional duties as assigned in support of the department’s quality and performance objectives.

Qualifications

• Required: High School Diploma or equivalent.
• Preferred: Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field.
• Mandatory Certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or an equivalent credential.
• Experience: Minimum of 5 years in revenue cycle auditing, billing, or coding; experience with urgent care or multi-setting healthcare preferred.
• Experience with Athena EMR strongly preferred.
• Strong understanding of the entire revenue cycle, including patient registration, authorizations, coding, claim submission, payment posting, denials, and collections.
• Experience with audit platforms, EMRs, and billing systems; proficient in Microsoft Office Suite.
• Excellent communication skills, both written and verbal, with a collaborative and patient-focused mindset.
• Demonstrated ability to analyze complex data, lead projects, and educate peers on compliance standards and best practices.

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• No weekends

Work Location: In person