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OpenLoop is a telehealth platform enabling virtual care delivery across all 50 states. As Senior Director of RCM & RPM Audit, you will lead the independent audit function for Revenue Cycle Management and Remote Patient Monitoring—the two highest-risk areas for the company. You report to the VP of Compliance, Healthcare, and sit as a peer to the Sr. Director of Compliance & Regulatory Affairs, ensuring audit independence from control design.
Your core responsibilities include designing and executing audit plans that test coding accuracy, claims integrity, and billing submission quality across the full RCM lifecycle. You'll identify revenue leakage, denial trends, and overpayment exposure before they escalate to repayment obligations or regulatory enforcement. You'll audit RPM enrollment eligibility, patient consent documentation, device FDA clearance, and CPT code time-threshold compliance (99453, 99454, 99457, 99458) against CMS and payer requirements.
You'll partner with Billing and RCM Operations on corrective action, defining findings and confirming remediation. You'll coordinate with Legal on disclosure and self-reporting obligations. You'll develop the annual audit work plan, present findings and risk ratings to the VP of Compliance and Compliance Committee, and maintain audit-ready documentation supporting OIG Element 6 (independent monitoring) of the enterprise compliance program.
You'll build and lead a small audit team (RCM Audit Lead + RPM Compliance & Audit Analyst), setting standards and developing talent. You'll translate audit findings into executive-ready risk summaries that drive action.
Required: 7–10 years in healthcare compliance, revenue cycle, or coding audit with strong domain expertise. Demonstrated audit independence (separate from compliance program design). Deep knowledge of CMS billing rules and RPM CPT requirements. Familiarity with OIG Seven Elements guidance, particularly Element 6. Preferred: telehealth or remote monitoring audit experience; CPC, CHC, CPCO, or AHIMA coding credential. You're a systems thinker comfortable building a function from the ground up, calm in ambiguity, and a low-ego collaborator with high integrity.
