Director, RCM & RPM Audit

Job description

ABOUT OPENLOOP OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring care anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states. About the Role As Director, RCM/RPM Audit, you will provide independent, senior-level audit coverage of the two functions that carry our most concentrated financial and coding risk: Revenue Cycle Management (RCM) and Remote Patient Monitoring (RPM). You'll report to the VP of Compliance, Healthcare, and sit alongside the Sr. Director of Compliance & Regulatory Affairs as a peer — the separation is intentional, since the team that designs controls should not be the team that tests them. You'll own the independent audit function and feed findings directly into the compliance program's corrective-action workflow. What You'll Do - 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. - Other duties as assigned. Who You Are - 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 (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. OUR BENEFITS In addition, for salaried positions you would also be eligible for: - Medical, Dental, and Vision plans - Flexible Spending/Health Savings Accounts - Flexible PTO - 401(k) + Company Match - Life Insurance, Pet insurance, and more OUR COMPANY We have a relatively flat organizational structure here at OpenLoop. Everyone is encouraged to bring ideas to the table and make things happen. This fits in well with our core values of Autonomy, Competence and Belonging, as we want everyone to feel empowered and supported to do their best work. Sound like a good fit? We’d love to meet you.