The RCM Auditor - Back-End Revenue Cycle is responsible for evaluating the accuracy, efficiency, and compliance of back-end revenue cycle processes and procedures. This role conducts detailed account audits, reviews, and analyses across back-end Revenue Cycle operations to measure adherence to standard operating procedures, identify discrepancies, reduce risk, and support improved collections and reimbursement outcomes.

This individual will initially be onboarded in a Quality Auditor capacity, conducting account-level audits to build deep familiarity with workflows, standards, and common variance patterns across the revenue cycle. After this onboarding period, the role is expected to transition into a Quality Audit Oversight function, where the auditor will review previously audited accounts, validate audit accuracy, ensure consistency in scoring and interpretation, and support audit integrity across vendors.

This role supports audits across select revenue cycle functions. Candidates should have demonstrated experience in at least one of the following areas: Accounts Receivable, including hospital and physician billing, follow-up, denials, and appeals, or Cash, including cash posting and reconciliation.

Key Responsibilities

Quality Auditor Responsibilities

• Demonstrate knowledge of and commitment to Healthrise Core Values 
• Perform audit planning, execution, and documentation using established methodologies and tools 
• Assess the effectiveness, efficiency, and integrity of revenue cycle processes 
• Ensure compliance with contracts, standard operating procedures, policies, and regulatory requirements 
• Identify revenue cycle issues and support corrective actions that improve financial performance 
• Maintain adaptability to evolving regulatory requirements, technologies, and organizational priorities 

Accounts Receivable Audit Responsibilities

• Conduct formal audits of hospital and physician billing, follow-up, and adjustment activities 
• Analyze, categorize, and evaluate claim denials across commercial, government, and managed care payers 
• Verify that appeals and reconsiderations are filed within payer-specific timelines and regulatory requirements 
• Assess the accuracy and appropriateness of account actions, including adjustments, transfers, and follow-up activity 

Cash Audit Responsibilities

• Conduct formal audits of cash posting, payment application, and reconciliation processes across multiple payer types 
• Verify balancing accuracy between payments received and amounts posted in financial systems 
• Ensure timely reconciliation and resolution of unapplied and misapplied payments 
• Evaluate adherence to cash posting standards, including ERA, EFT, and manual workflows 
• Maintain knowledge of payer payment methodologies, remittance advice formats, and best practices for cash operations 

Quality Audit Oversight Responsibilities

• Provide oversight of audit quality across back-end revenue cycle functions to ensure consistency, accuracy, and adherence to standards 
• Serve as a subject matter expert to validate audit findings against payer guidelines, regulatory requirements, and internal policies 
• Review auditor disputes and determine final outcomes in partnership with Operational Excellence leadership 
• Identify systemic trends, variances, and root causes across audit findings and translate them into actionable recommendations 
• Prepare and present audit summaries, trend analyses, and performance insights to leadership 
• Partner with operations and training teams to support standardization, calibration, and ongoing education based on audit findings 
• Ensure consistency in audit methodologies, scoring application, and interpretation across auditors and functional areas 
• Maintain advanced knowledge of regulatory requirements, payer behaviors, and industry best practices 

Accounts Receivable Oversight Responsibilities

• Provide oversight and validation of audit outcomes related to billing, follow-up, adjustments, and denial management 
• Ensure consistency in root cause identification and denial and underpayment classification across auditors 
• Validate adherence to payer-specific timelines and requirements for appeals and reconsiderations, including a focus on California payers 

Cash Oversight Responsibilities

• Provide oversight and validation of audit outcomes related to cash posting, payment application, and reconciliation processes 
• Ensure consistency in evaluation of unapplied and misapplied cash resolution and reconciliation practices 
• Guide audit standards related to payer payment methodologies, remittance processing, and cash workflow best practices 

• High school diploma or equivalent 
• At least 3 years of experience in hospital back-end revenue cycle operations, including Accounts Receivable and/or Cash functions such as payment posting and reconciliation 
• Experience working across commercial, government, and managed care environments 

Preferred

• Associate’s or bachelor’s degree 
• CRCR, CHFP, CQPA, or similar certification 
• Experience with Epic EHR 

Work Environment

• This role operates in a professional home-based work environment 
• A quiet and private workspace is required 
• Employees must maintain a professional environment during video calls, including professional attire when on camera 
• Standard office equipment such as computers and phones is routinely used 
• All work must comply with HIPAA and other healthcare privacy regulations 
• Only organization-approved devices and secure VPN connections may be used 
• No patient information may be stored on personal devices 

Physical Demands

• This is primarily a sedentary role 
• Frequent use of a keyboard, mouse, and other devices is required for typing, clicking, and navigating systems 
• An ergonomically safe workspace is encouraged