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 secure, 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:
Hybrid Work Opportunity, Health Insurance, Accidental wellness cover, Company provided devices, Internet reimbursement, 20 total leaves(+Maternity, paternity & Bereavement leave), 10 Holidays (including optional)



About The Opportunity We are looking for an experienced Senior RCM Audit & Compliance Specialist to oversee auditing and compliance activities across our US healthcare operations. The individual will be responsible for reviewing clinical documentation, billing practices, claims, and operational workflows to ensure adherence to US healthcare regulations, Medicare guidelines, payer policies, and internal compliance standards. Role & Responsibilities
• Conduct regular internal audits of RCM processes, including patient eligibility, documentation, coding, billing, and claims.
• Review patient records to ensure that services billed are supported by appropriate clinical documentation.
• Audit RPM and CCM patient encounters, time logs, monitoring records, and provider documentation.
• Identify billing discrepancies, documentation gaps, coding errors, and process inefficiencies.
• Perform pre-billing and post-billing audits to minimize claim denials and compliance risks.
• Ensure compliance with CMS guidelines and Medicare requirements applicable to RPM and CCM services.
• Review patient enrollment, consent documentation, medical necessity, care plans, and provider involvement.
• Verify compliance with applicable CPT requirements, including time-based billing and device monitoring requirements.
• Ensure appropriate documentation of patient interactions, clinical activities, and monitoring thresholds.
• Stay updated on changes in CMS regulations, reimbursement policies, and payer-specific requirements.
• Review CPT and ICD-10 coding accuracy and validate supporting documentation.
• Audit claims for incorrect coding, duplicate billing, upcoding, and unsupported services.




• Ensure billing practices align with Medicare, Medicaid, and commercial payer policies.
• Work with billing and RCM teams to investigate claim denials and recurring billing issues.
• Recommend corrective actions to reduce revenue leakage and improve first-pass claim acceptance.
• Ensure adherence to applicable US healthcare regulations, including HIPAA and relevant CMS requirements.
• Support internal compliance assessments and external audits.
• Identify potential compliance risks and recommend preventive measures.
• Maintain audit trails, compliance records, and supporting documentation.
• Assist in developing and updating SOPs, audit checklists, and compliance policies.
• Prepare periodic audit reports highlighting findings, error rates, trends, and compliance gaps.
• Develop corrective and preventive action plans (CAPA).
• Conduct root cause analysis of recurring audit failures and claim denials.
• Train relevant teams on documentation standards, billing compliance, and audit observations.
• Collaborate with Clinical Operations, RCM, Finance, and US stakeholders to improve operational accuracy.cl Must-Have Skills & Qualifications
• Bachelor's degree in Healthcare Administration, Life Sciences, Nursing, Medical Coding, or a related field.
• 10+ years of experience in US healthcare RCM auditing, billing compliance, or healthcare quality assurance.
• Strong understanding of US healthcare billing and reimbursement processes.
• Practical knowledge of RPM and CCM workflows and Medicare billing requirements.
• Knowledge of CPT, ICD-10, CMS guidelines, and payer-specific billing policies.
• Understanding of HIPAA regulations. Equal Opportunity Sciometrix 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.

Skills:
capas,cpt coding,icd,rcm audit,ccm,cms,rcm,medical coding,hipaa

📌 Senior RCM Audit (Gurugram)
🏢 SCIOMETRIX
📍 Gurugram