At
Sciometrix
, our goal is to deliver the best-ever personalized care with utmost compassion enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value-Based Care, and Population Health.We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes. Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services.At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well-being and provider efficiency. With Sciometrix, the future of healthcare is not just about treating illnesses; it's about empowering patients to live their best lives.
What's In It For You
🚀
Dynamic Startup Culture:
Cultivate a security-focused mindset within our agile startup environment, advocating for proactive risk management and continuous improvement as fundamental pillars, enabling us to thrive in the fast-paced world of web development.⚧️
Commitment to Diversity:
We are paving the way to create change in the industry and our leadership is committed to diversity, inclusion and belonging🌍
Global Network:
Expand your global network by developing, learning, and growing with our top talent and connections around the world🤝🏻
Community of Belonging:
As a community of belonging, we prioritize creating an environment where everyone feels safe, empowered, and valued. Our organization is committed to fostering continual growth and cultivating the ideal atmosphere that enables you to bring forth your best self at work.
🌟Benefits
- Remote work opportunity (Company provided devices)
- Health insurance
- Accidental wellness cover
- Internet reimbursement
- 20+ paid leaves
- 10 holidays (including optional)
Position Summary
We are seeking a
Quality Auditor
(CCM & RPM Programs) for
Pre-Bill Audit Team (RCM department) to ensure the accuracy, compliance, and integrity of claims submitted under Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs. The ideal candidate will have in-depth knowledge of U.S. healthcare regulations, CMS guidelines, and hands-on experience in auditing medical claims and documentation.
Key Responsibilities
- Conduct routine and targeted audits of claims related to CCM and RPM.
- Verify documentation and billing accuracy in line with CMS guidelines and U.S. healthcare compliance standards.
- Identify errors, inconsistencies, or potential fraud in submitted claims and recommend corrective actions.
- Collaborate with operational and clinical teams to ensure proper documentation supports billed services.
- Track audit findings, analyze trends, and prepare detailed reports for management to drive continuous improvement.
- Stay current with changes in healthcare regulations and payer requirements specific to CCM and RPM.
- Participate in internal compliance training and quality improvement initiatives.
- Provide constructive feedback and training to relevant teams to address recurring compliance issues.
Required Qualifications
- Bachelor’s degree in any discipline.
- Minimum of 2 years’ experience in healthcare claims auditing, preferably in CCM and RPM services.
- Strong understanding of U.S. healthcare systems, CMS billing guidelines, HIPAA, and other regulatory requirements.
- High attention to detail with excellent analytical and problem-solving skills.
- Strong written and verbal communication skills.
Shift Timings:
8:00 AM – 5:00 PM ESTSciometrix is an
Equal Opportunity Employer
and is proud to offer equal employment opportunity to everyone regardless of race, color, ancestry, religion, gender, national origin, sexual orientation, age, citizenship, disability, gender identity, veteran status, and more. Join us at
Sciometrix
and be part of a team dedicated to transforming healthcare through telehealth innovation.Skills: hipaa,rpm,ccm,cms guidelines,verify documentation,cms billing,audits of claims,u.s. healthcare systems,chronic care management,quality assurance processes,medical transcription,cms,billing process,pre bill audit,internal compliance,rcm,clinical operations
