Sage Clinical RCM, LLC · 2 days ago
Professional Billing (PB) Auditor – Surgical Specialty
United States
Full-time
Remote
Entry, Mid Level
2+ years expSage Clinical RCM, LLC is a healthcare organization seeking a Professional Billing (PB) Auditor – Surgical Specialty to provide ongoing audit support for hospital-based physician billing. The role focuses on auditing professional fee claims for complex surgical services to ensure accurate coding and regulatory compliance, while also supporting continuous improvement and education for coding staff.
Hospital & Health Care
Responsibilities
Perform retrospective and/or concurrent audits of professional billing surgical claims
Review operative reports and supporting documentation to validate appropriate CPT, HCPCS, and ICD-10-CM code assignment
Validate modifier usage and bundling in accordance with NCCI edits and payer guidelines
Identify surgical coding trends, compliance risks, and opportunities for improvement
Provide clear, educational feedback to professional billing coders related to surgical coding accuracy
Document audit findings and recommendations in accordance with established audit standards
Support internal and external audit preparedness related to professional fee surgical services
Ensure compliance with CMS, AMA, and payer-specific billing regulations
Qualification
Required
Minimum 2+ years of professional billing auditing experience with a focus on surgical services
Strong knowledge of CPT (Surgery section), ICD-10-CM, modifiers, and NCCI edits
Experience auditing hospital-based physician surgical billing claims
Strong written and verbal communication skills with the ability to provide constructive audit feedback
Preferred
CPC, CPMA, or equivalent certification preferred
Company
Sage Clinical RCM, LLC
Sage Clinical RCM is a tech-enabled clinical revenue cycle firm transforming how healthcare organizations achieve clarity, accuracy, and performance across the revenue cycle.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase