Related skills
cms compliance audit cpt/hcpcs qa/qc📋 Description
- Design and implement QA/QC framework across service lines and locations
- Establish formal audit standards and inspection protocols
- Define quality control checkpoints within revenue cycle workflows
- Develop structured sampling methodologies and risk-based audit prioritization
- Lead quality validation during onboarding and system transitions
- Ensure RCM compliance with CMS regs, MAC LCD/NCD, and payer requirements
🎯 Requirements
- 7+ years in healthcare revenue integrity, auditing, or quality management
- Experience designing multi-site QA/QC or revenue integrity programs
- CMS billing regs, CPT/HCPCS, MAC LCD/NCD, Medical Necessity expertise
- Experience managing audit documentation and corrective action workflows
- Strong analytical skills to interpret complex billing data and guidance
- Executive-level written and verbal communication skills
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