The Accounts Receivable (AR) Auditor ensures the accuracy, efficiency, and compliance of accounts receivable activities within Revenue Cycle Management. This role conducts audits, reviews, and analyses of AR operations to identify discrepancies, reduce risk, and strengthen collections and reimbursement performance.

Duties and Responsibilities

• Conduct audits of AR processes, including payment posting, adjustments, and follow-up activities, to ensure compliance with contracts, policies, and regulatory requirements.
• Analyze, categorize, and resolve claim denials from California commercial, government, and managed care payers.
• Identify root causes of denials, recommend solutions, and support corrective actions to optimize financial performance.
• Plan, execute, and document audits using appropriate methodologies and tools to assess efficiency and integrity of revenue cycle processes.
• Ensure appeals and reconsiderations are submitted according to California payer timelines and regulatory standards.
• Adapt to evolving regulatory changes, technology updates, and organizational priorities.
• Prepare audit reports, summaries, and recommendations for management. Communicate findings and trends to stakeholders to support decision-making and process improvement.

Required

• High School Diploma or equivalent. Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field preferred.  
• Experience with California Medicaid, Share of Cost, and managed care environments.  
• 2–3 years of experience with California-specific payers (Medi-Cal, Blue Shield of CA, Kaiser, CalOptima, IEHP, Partnership HealthPlan, Division of Financial Responsibility, Share of Cost).  

Preferred

• Certified Professional Biller (CPB), Certified Reimbursement Specialist (CMRS), or equivalent.