Position Summary:
HBiz is seeking an experienced and highly organized Manager of Audit to lead all audit-related operations across government, commercial, and post-payment audits. This fully remote role will report directly to the VP of Clinical Appeals and is responsible for overseeing end-to-end audit processes, ensuring regulatory compliance, and managing a team that includes offshore staff. The ideal candidate is a strong communicator, detail-oriented, and comfortable working flexible hours to support coordination across global teams and time zones.
Key Responsibilities:
- Audit Oversight & Lifecycle Management
- Lead the management and response process for a variety of audits including RAC, MAC, CERT, PERM, TPE, and commercial payer audits.
- Oversee case intake, documentation collection, quality review, and timely submission.
- Track and analyze audit trends, denials, and appeal outcomes to identify risks and recommend improvements.
- Reporting & Tracking
- Maintain detailed audit logs and status reports using audit tracking systems.
- Develop and deliver regular audit performance dashboards and summaries to leadership.
- Identify audit trends and provide insights for proactive risk mitigation.
- Team Management & Workflow Coordination
- Supervise and support a team of audit staff, including managing offshore resources.
- Assign and coordinate cases with clinical, coding, technical, and documentation teams.
- Ensure efficient workflows and balanced workloads across team members.
- Work flexible hours when needed to support offshore operations and tight deadlines.
- Collaboration Across Departments
- Act as the liaison between clinical, coding, HIM, compliance, and IT teams for audit support.
- Ensure audit responses include accurate, complete, and compliant documentation.
- Facilitate escalation and resolution of complex audit issues.
- Compliance & Quality Assurance
- Ensure all audit activity complies with CMS, commercial payer, and regulatory requirements.
- Support policy and process development to strengthen audit readiness and response.
- Participate in internal audits and risk assessments as needed.
Qualifications:
- Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or related field (Master’s preferred).
- Minimum 5 years of healthcare audit experience, including government and post-payment audits.
- At least 2 years in a supervisory or leadership role, including managing remote/offshore staff.
- In-depth understanding of audit regulations, payer requirements, and healthcare reimbursement.
- Familiarity with medical coding (ICD-10, CPT, HCPCS), billing practices, and clinical documentation standards.
- Excellent communication, organizational, and leadership skills.
- Proficient with audit tracking software, EHRs, and Microsoft Office Suite.
The ideal candidate is articulate, organized, detail-oriented, and able to adjust their schedule as needed to engage with teams across a global network and multiple time zones.
Acts as a liaison between internal Hbiz clients, (i.e.: coding, HIM, compliance, and IT teams); as well as external clients we are supporting with our services.