Healthcare RCM Audit Manager

The vision of Smile Doctors is our people-first culture which creates an environment of passionate, caring Team Members dedicated to providing fun and encouraging relationships with each other and our patients. Smile Doctors offers every Team Member the opportunity to be a part of something bigger. We focus on the importance of the individual and recognize that each person on our Team has something great to offer. We recognize talents and strengths and take care to nurture those abilities to help our Team Members grow into successful people in their careers, in our organization, and beyond.

We are looking for a Healthcare RCM Audit Manager to join our team.

If you are looking for an opportunity to be a part of a growing company and industry leader, Smile Doctors is the place for you. We operate the largest national network of orthodontic clinics with locations in more than 20 states.  At Smile Doctors, we excel at providing exceptional patient care.

What We Offer

• Competitive salary
• Medical, dental, vision and life insurance
• Short and long-term disability coverage
• 401(k) plan
• 3 weeks paid time off in your first year + paid holidays

• Discounts on braces and clear aligners for you and your family members

What You’ll Do

• Audit Planning and Execution:
  • Develop audit plans based on organizational goals, industry regulations, and best practices.
  • Execute audits of revenue cycle processes, including patient contracting, insurance and patient accounts receivables, cash management, coding, coding, claims processing, revenue integrity, and overall reimbursement by comparing to company policies and protocols.
  • Conduct and oversee testing of individual transactions and adjustments to determine overall compliance with company, payor, and government policies and protocols.
  • Assess the effectiveness and efficiency of internal controls and identify areas for improvement.
  • Compile audit results in an audit report format to identify employee, clinic, payor and/or system deficiencies as well as identify overall workflow and operating efficiencies that would lead to increased revenue and accuracy.
  • Create and execute communication plans to key stakeholders, including clinic team members on audit results and action plans to address any deficiencies identified
• Collaboration and Training:
  • Collaborate with cross-functional teams, including billing, accounts receivable, cash management, operations, coding, finance, and clinical departments.
  • Provide training and education to staff regarding revenue cycle best practices, compliance, and audit findings.
• Process Documentation:
  • Develop and maintain procedural documentation.
  • Create and support the creation of flow charts to support procedural audits.
  • Actively engage in the development of policies and job aids for the RCM department.
• Data Analysis and Reporting:
  • Utilize data analytics tools to analyze financial and operational data related to the revenue cycle and incorporate into the audit process.
  • Generate reports highlighting audit findings, trends, and opportunities for improvement.
  • Present findings to key stakeholders and collaborate on action plans.
• Regulatory Compliance:
  • Stay current with healthcare regulations, payer guidelines, and industry trends.
  • Ensure compliance with coding and billing regulations, such as HIPAA and Medicaid.
  • Provide guidance on regulatory changes and their impact on revenue cycle management.

What You’ll Need

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field
• Five+ years of experience in healthcare revenue cycle management, auditing, or a related field
• In-depth knowledge of healthcare revenue cycle processes, coding principles, and regulatory requirements
• Previous experience with coding and compliance audits is strongly preferred

• Advanced knowledge of Excel required (Vlookup, Index, Match and pivot tables)
• Intermediate knowledge of business intelligence software preferred (PowerBI or similar tool)
• Intermediate knowledge of internal audit program and methodologies
• Intermediate knowledge of RCM cycle input and outputs
• Intermediate knowledge of core revenue cycle KPIs and metrics including methodologies to calculate widely accepted industry standard KPIs required
• Solid customer service skills required
• Experience with auditing tools and data analytics is preferred

This is the perfect opportunity to grow with an expanding organization! Apply today!

Smile Doctors and all our affiliating practices are proud to be an equal opportunity workplace and welcome diversity in our organization.  We do not discriminate against any team member or applicant for employment regardless of age, race, color, national origin, religion, disability, veteran status, sex, sexual orientation, or gender identity.