Health Business Solutions LLC

 Manager, Post-Pay Audit

Job Summary:

We are seeking a detail-oriented and driven Post-Pay Audit Manager to lead a team of auditors performing retrospective audits across commercial and government payers. Reporting directly to the Director of Post-Pay Audit, this role is responsible for daily operations management, performance oversight, and quality assurance across onshore and offshore teams, including staff based in the Philippines.

The ideal candidate has experience in medical claims auditing, strong leadership capabilities, and a solid understanding of Medicare, Medicaid, and other payer reimbursement requirements. This position plays a key role in maximizing revenue recovery while ensuring compliance and process excellence.

Key Responsibilities:

• Supervise daily audit operations across onshore and offshore teams, ensuring accuracy, productivity, and timely completion of audit deliverables.
• Provide hands-on leadership, training, and mentorship to audit staff, fostering a high-performance and quality-focused team culture.
• Monitor performance metrics, individual KPIs, and quality assurance results to drive continuous improvement.
• Coordinate the execution of audits for government (RAC, UPIC, MAC) and commercial payers, ensuring adherence to payer policies and audit guidelines.
• Collaborate with the Director of Post-Pay Audit on staffing, planning, and workflow optimization across multiple time zones.
• Conduct regular audit reviews, spot checks, and root cause analysis to ensure compliance and identify patterns of underpayment or denial.
• Escalate complex audit findings or payer discrepancies to senior leadership as needed.
• Assist in the development and implementation of standard operating procedures (SOPs) and training documentation.
• Support audit readiness and documentation for internal and external quality audits.
• Foster strong communication between onshore and offshore teams to ensure alignment on goals and expectations.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Health Information Management, Business, or related field required.
• Minimum of 5 years of experience in medical auditing, revenue cycle management, or claims recovery.
• At least 2 years in a supervisory or team lead role, preferably with remote or offshore team management experience.
• Solid knowledge of government audit programs (RAC, MAC, Medicaid Integrity, UPIC) and commercial payer policies.
• Proficiency in healthcare billing, medical coding (ICD-10, CPT, HCPCS), and EOB analysis.
• Strong analytical, organizational, and decision-making skills.
• Experience using audit/recovery software platforms and workflow tools.
• Professional certification preferred (e.g., CPMA, CPC, RHIA, CHC).
• Ability to work cross-functionally in a dynamic, deadline-driven environment.