Sr. Director, RCM & RPM Audit

Responsibilities

• Design and execute audit plans testing coding accuracy, claims integrity, and submission quality across the full billing lifecycle.
• Identify revenue leakage, denial trends, and overpayment exposure before they become repayment obligations or enforcement matters.
• Monitor adherence to payer contract terms and flag variances to leadership.
• 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 action — define the finding, own the follow-through, and confirm remediation closed the gap.
• Cook with Legal when findings create disclosure or self-reporting obligations.
• Deliver the independent auditing and monitoring function required by OIG Element 6 — your work feeds directly into the enterprise compliance program.
• Develop the annual audit work plan and present results, trends, and risk ratings to the VP of Compliance and the Compliance Committee.
• Build and lead a small audit team (RCM Audit Lead + RPM Compliance & Audit Analyst); set standards, develop talent, and model the discipline you expect.
• Maintain audit-ready documentation supporting a defensible record of monitoring under OIG Element 6, and proactively identify systemic risk patterns as RPM volume scales.
• Other duties as assigned.

Qualifications

• 7–10 years in healthcare compliance, revenue cycle, or coding audit, with strong domain expertise.
• Demonstrated independence — audit experience separate from compliance program design.
• Deep working knowledge of CMS billing rules and RPM CPT requirements (CPT 99453, 99454, 99457, 99458).
• Familiarity with OIG guidance on effective compliance programs (Seven Elements), particularly Element 6.
• Experience auditing telehealth or remote monitoring programs strongly preferred.
• CPC, CHC, CPCO, AHIMA coding credential, or equivalent a plus.
• Ability to translate audit findings into executive-ready risk summaries — findings reports that drive action, not confusion.
• Comfortable building a function from the ground up; systems thinker who is calm in ambiguity.
• High integrity and sound judgment; low-ego collaborator who partners well with Billing, RCM Operations, and Legal.