RCM Quality Assurance & Compliance Specialist

RCM Quality Assurance & Compliance Specialist

This role audits revenue-cycle work, identifies operational and compliance risk, and helps teams prevent errors before they affect patients, clients, payers, or collections.

Responsibilities

• Audit claims, account notes, coding-related workflows, eligibility, authorization, payment posting, A/R, denials, and client reports against approved standards.

• Track error rates, root causes, corrective actions, and repeat findings; maintain defensible audit documentation.

• Review adherence to payer, client, HIPAA, privacy, security, minimum-necessary, ethical-billing, and company requirements.

• Escalate suspected overbilling, underbilling, false documentation, improper access, conflicts, retaliation, privacy incidents, or other misconduct immediately.

• Support training, SOP improvements, calibration, quality dashboards, and corrective-action follow-up.

• Preserve evidence and cooperate with lawful internal, client, payer, and regulatory reviews.

Qualifications

• Two or more years of healthcare RCM, billing, coding, denial, audit, compliance, or quality experience preferred.

• Strong knowledge of claims, EOB/ERA review, payer requirements, documentation standards, and common revenue-cycle risks.

• Excellent analytical judgment, attention to detail, written communication, and discretion.

• CPC, CPB, CRCR, CHC, auditing, or related credential preferred but not required unless stated in an offer.

Independence and Non-Retaliation

The specialist must report findings objectively and must not alter, suppress, backdate, or conceal records. Good-faith reporting and participation in reviews are protected from retaliation. The role has no authority to provide legal advice or bind AdvantixxRCM or a client.

Performance

Success includes audit accuracy, timely escalation, corrective-action closure, repeat-error reduction, documentation quality, training effectiveness, and protection of patient, client, payer, and company information.

Employment Notice

This is a full-time U.S. employee opportunity with remote eligibility. Final classification, schedule, location, compensation, and benefits will be stated in the written offer. Employment is contingent on applicable identity, work-authorization, background, credential, and reference verification and required agreements. AdvantixxRCM is an equal opportunity employer.