Health Business Solutions LLC

Job Summary:

We are seeking a highly experienced and strategic Director of Post-Pay Audit to lead our medical revenue recovery audit teams across both onshore (U.S.) and offshore (Philippines) operations. This leader will be responsible for overseeing the execution of comprehensive post-payment audits across commercial and government payers (Medicare, Medicaid, TRICARE, etc.), ensuring compliance, accuracy, and maximum revenue recovery for healthcare provider clients.

The ideal candidate brings deep knowledge of healthcare reimbursement policies, government audit programs (e.g., RAC, UPIC, MAC), and a proven ability to lead cross-functional and cross-cultural teams at scale.

Key Responsibilities:

• Lead and manage the end-to-end post-pay audit function, including planning, execution, quality assurance, and reporting.
• Direct and support a global team of audit professionals, ensuring productivity, accuracy, and compliance across both U.S.-based and Philippines-based operations.
• Oversee audit processes related to government payers and regulatory programs (e.g., CMS RAC, Medicaid Integrity Program, etc.).
• Establish and refine audit workflows, KPIs, and escalation protocols to optimize audit yield and recovery timelines.
• Collaborate with compliance, legal, and analytics teams to identify audit opportunities and mitigate risk.
• Serve as the subject matter expert for payer audit guidelines, CMS regulations, and state-specific requirements.
• Build strong relationships with internal stakeholders and clients to align audit strategies with broader revenue recovery goals.
• Develop and execute training programs and professional development plans for onshore and offshore audit staff.
• Ensure adherence to internal quality standards, HIPAA regulations, and client-specific SLAs.
• Analyze audit outcomes and present regular performance and risk reports to senior leadership.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required; Master’s or MBA preferred
• Minimum of 7–10 years of experience in post-payment auditing, healthcare reimbursement, or revenue recovery
• Proven experience managing global teams, including operations based in the Philippines
• Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits)
• Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies
• Demonstrated ability to lead process improvement initiatives in large-scale audit operations
• High proficiency with audit and recovery systems, reporting tools, and workflow platforms
• Strong communication, leadership, and analytical skills
• Certification in auditing, billing, or compliance (e.g., CPMA, CPC, CHC) is a plus