Audit and Complaince MedicalBilling (US-Healthcare)

Meds IT Nexus is looking for an experienced executive-level Manager – Audit & Compliance with deep expertise in US Healthcare Revenue Cycle Management (RCM). This leadership role is responsible for overseeing organizational quality assurance, building strong compliance frameworks, and protecting the operational integrity of US client accounts. The ideal candidate will have a solid background in audit and regulatory compliance within medical billing, ensuring strict adherence to healthcare laws and industry standards.

Key Responsibilities
Lead and execute enterprise-wide Quality Assurance (QA) and regulatory compliance initiatives across all RCM functions, including Charge Entry, Coding, Payment Posting, Accounts Receivable, and Credentialing. Develop, revise, and enforce internal compliance policies, audit checklists, and Standard Operating Procedures (SOPs) aligned with HIPAA, OIG guidelines, and relevant US healthcare regulations. Conduct routine, random, and targeted compliance audits to detect billing errors, documentation gaps, fraudulent activities, and coding inconsistencies. Perform thorough root-cause analyses on audit findings, compliance risks, and claim denials, and design effective Corrective Action Plans (CAPs) to resolve issues promptly. Serve as the primary compliance liaison for executive leadership and US clients, delivering comprehensive compliance risk assessments and audit scorecards. Supervise, train, and mentor Team Leads and Senior Auditors on regulatory updates, CPT/ICD-10 coding compliance, and data security protocols. Manage internal risk assessments, client escalation audits, and ensure readiness for external client or regulatory compliance reviews.

Required Qualifications
A minimum of 7 to 10+ years of experience in US Medical Billing and Revenue Cycle Management, with at least 3 to 4 years in leadership roles managing Audit, Quality Assurance, or Regulatory Compliance teams. Expert knowledge of RCM audit methodologies, HIPAA privacy and security regulations, OIG compliance standards, CPT/ICD-10 coding guidelines, and Medicare/Medicaid policies is essential. Proficiency in major EHR/RCM software platforms such as AdvancedMD, eClinicalWorks, Kareo/Tebra, Practice Fusion, OfficeAlly, EncoderPro, and various Payer Portals is required. Advanced Microsoft Excel skills, including data analytics, trend modeling, pivot tables, and audit sampling techniques, are necessary. Strong leadership qualities combined with excellent analytical problem-solving skills and superior written and verbal communication in English are critical. A Bachelor’s or Master’s degree in Healthcare Administration, Business, Law, or Finance is required. Professional certifications such as CPCO, CHC, or CPMA are highly preferred.

Preferred Qualifications and Benefits
This position offers a competitive executive-level salary package, including compliance performance bonuses, annual loyalty rewards, regular salary increments, inflation allowances, and participation in the Employee Equity Funds Program (EEFP). The role provides fixed weekends off (Saturday and Sunday) to promote work-life balance. Office amenities include complimentary dinner and daily tea/green tea breaks. Employee support benefits encompass paid leaves, leave encashment options, corporate loan facilities, and advance salary benefits. This is a night shift position based in Rawalpindi, requiring in-person attendance at the company’s office on Murree Road. Candidates should consider commute feasibility for night shifts.

Applicants are encouraged to share details of their audit and compliance experience within medical billing, current and expected salary, notice period status, and willingness to commute for night shifts.