Posting DetailsPosition Information
Posting Number NONAC3798
Job Title Sr. Claims Auditor - Revenue Integrity
Position Title Sr. Claims Auditor - Revenue Integrity
Position Type Non-Faculty
Number of vacancies 1
Salary Commensurate upon experience
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.
Key Competencies- 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 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
Open Until Filled No
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.
Quick Link https://careers.msm.edu/postings/24595
Job Duties
