[Remote] Professional Billing (PB) Auditor – Surgical Specialty

Note: The job is a remote job and is open to candidates in USA. Sage 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. 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 Skills • 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 • CPC, CPMA, or equivalent certification preferred Company Overview • Sage Clinical RCM is a tech-enabled clinical revenue cycle firm transforming how healthcare organizations achieve clarity, accuracy, and performance across the revenue cycle. It was founded in 2024, and is headquartered in Gulfport, Florida, US, with a workforce of 51-200 employees. Its website is https://sageclinicalrcm.com/. Apply tot his job Apply To this Job