openloophealth - Sr. Director, RCM & RPM Audit

• RCM audit: 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. • RPM compliance & audit: 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. • Corrective action: Partner with billing and RCM operations on corrective action — define the finding, own the follow-through, and confirm remediation closed the gap. Coordinate with Legal when findings create disclosure or self-reporting obligations. • Program leadership & OIG alignment: 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. • Team building: Build and lead a small audit team (RCM Audit Lead + RPM Compliance & Audit Analyst); set standards, develop talent, and model the discipline you expect. • Documentation: Maintain audit-ready documentation supporting a defensible record of monitoring under OIG Element 6, and proactively identify systemic risk patterns as RPM volume scales.