Sr. Director, RCM & RPM Audit

Responsibilities

• Design and execute audit plans testing coding accuracy, claims integrity, and submission quality across the full billing lifecycle for RCM.
• Identify revenue leakage, denial trends, and overpayment exposure.
• Monitor adherence to payer contract terms and flag variances.
• Audit RPM enrollment eligibility, patient consent documentation, and program onboarding against CMS and payer requirements.
• Review time-tracking records and billing submissions for adherence to CPT code time thresholds (CPT 99453, 99454, 99457, 99458).
• Validate that RPM devices carry appropriate FDA clearance and are used within intended use.
• Partner with billing and RCM operations on corrective actions, own follow-through, and confirm remediation.
• Coordinate with Legal on disclosure or self-reporting obligations.
• Deliver independent auditing and monitoring required by OIG Element 6.
• Develop annual audit work plan and present results, trends, and risk ratings to leadership and Compliance Committee.
• Build and lead a small audit team (RCM Audit Lead + RPM Compliance & Audit Analyst).
• Maintain audit-ready documentation and proactively identify systemic risk patterns.

Requirements

• 7–10 years in healthcare compliance, revenue cycle, or coding audit, with strong domain expertise.
• Demonstrated independence in audit experience separate from compliance program design.
• Deep working knowledge of CMS billing rules and RPM CPT requirements (99453, 99454, 99457, 99458).
• Familiarity with OIG guidance on effective compliance programs (Seven Elements), particularly Element 6.
• Ability to translate audit findings into executive-ready risk summaries.
• Comfortable building a function from the ground up; systems thinker comfortable in ambiguity.
• High integrity, sound judgment, and strong collaboration skills with Billing, RCM Operations, and Legal.

Nice-to-Haves

• Experience auditing telehealth or remote monitoring programs.
• CPC, CHC, CPCO, AHIMA coding credential, or equivalent.