Revenue Cycle Auditor

Join to apply for the Revenue Cycle Auditor role at Stance Health Solutions, uniting SG Homecare and Western Drug

The Revenue Cycle Auditor manages the revenue cycle, which includes generating, acquiring, and delivering revenue. Key responsibilities include processing and submitting claims to insurance companies and patients, following up on unpaid claims, resolving discrepancies with payers, ensuring timely collection of payments, and submitting necessary documentation to create revenue for insurance companies. The auditor interprets payer contracts, addresses revenue‑related issues, analyzes accounts receivable reports, identifies repetitive denials, and schedules meetings with payers.

They also identify internal organizational errors arising from other departments or system configuration and take appropriate action.

• Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information to minimize denials and delays.
• Review patient accounts to verify correct insurance billing information, update records as necessary, and resolve discrepancies in patient account balances.
• Analyze denied claims to identify denial reasons and perform follow‑up actions, including appealing denied claims with appropriate documentation and justification.
• Analyze accounts receivable reports and take appropriate action to resolve repetitive denials.
• Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement.
• Discuss areas needing improvement with the authorization and CMN departments as needed.
• Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience.
• Engage in written communication and schedule meetings with payers to address aging balances.
• Compile and submit projects to insurance companies.
• Meet with Revenue Cycle Manager and Director to discuss areas of concern.
• Process and submit authorization and CMN requests to medical groups, plans, and physicians’ offices; follow up in a timely manner.
• Process eligibility verification and determine payer, benefits, and coverage criteria.
• Monitor and report on key performance indicators related to revenue cycle activities, such as claim denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement.
• Work on complex and intricate revenue‑related matters.
• Support global team and provide feedback through QA, reviews and huddles.
• Monitor work completed by global partners and resolve tasks the global team cannot resolve.
• Submit price table, payer rule, and system configuration updates to designated team.
• Implement and adhere to compliance standards and regulations related to medical billing and coding, maintaining confidentiality of patient information in accordance with HIPAA guidelines.
• Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements.

• Minimum of 2 years’ experience in Revenue Cycle Management
• High school diploma or equivalent required
• Effective verbal and written skills
• Knowledge of all major insurance carrier reimbursement guidelines and eligibility coverage and claims processing guidelines (Medicare, Medi‑Cal, Commercial Health Plans)
• Thorough understanding of healthcare regulations, coding guidelines, and payer policies/contracts
• Able to work in a fast‑paced environment, flexible and able to adapt to changing environment
• Strong interpersonal, communication, time management, and organizational skills for effectively conveying audit findings to payers as well as with domestic and global staff
• Self‑starter with the ability to work independently
• Proficiency with Microsoft Excel
• Experience with Brightree EHR or other EHR system
• In‑depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle
• Strong analytical and problem‑solving abilities
• Working knowledge of MS Office
• Strong ability to analyze financial data, identify discrepancies, and conduct audits
• Exceptional precision in reviewing documents and data for accuracy

Physical Demands and Working Environment:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. The role requires a standard office setting; tasks are regularly performed without exposure to adverse environmental conditions; frequent interaction with staff and the public. Incumbents must wear a headset, access and work within multiple systems while addressing callers’ concerns in real time. The job may involve standing or sitting for prolonged periods, operating office equipment, light lifting, carrying, pushing and pulling, and verbal communication.