Overview
A healthcare technology organization is seeking a Senior Manager to lead its auditing team and oversee quality control functions. This role is responsible for ensuring operational objectives and quality metrics are met or exceeded. The Senior Manager will leverage auditing expertise and leadership skills to inspire a high-performing team and contribute to delivering AI-powered software solutions that enhance transparency and accuracy in healthcare payment services.
Responsibilities
- Lead and manage the DRG, Professional, and Outpatient audit teams.
- Coordinate onboarding and training to support employees and programs.
- Perform audits and quality reviews to ensure compliance with coding guidelines and client requirements.
- Conduct provider dispute audits.
- Provide quality and quantity reporting on the auditing team's performance to meet operational goals.
- Participate in hiring and training activities, including conducting auditor interviews and providing ongoing education and support.
- Collaborate with internal teams to understand and meet client performance expectations; may engage directly with clients.
- Maintain and apply up-to-date knowledge of coding guidelines, reimbursement trends, and healthcare payment policies.
Requirements
Must-haves
- Bachelor’s degree.
- Over 10 years of experience in inpatient coding, auditing, and quality review within payment integrity.
- At least 3 years of supervisory or management experience, including managing and training remote teams.
- Certified Coding Specialist (CCS) credential.
- Extensive knowledge of ICD-10-CM/PCS coding, MSDRG and APRDRG, and U.S. healthcare payment methodologies across Commercial, Marketplace, Medicare, and Medicaid.
- Excellent written and verbal communication skills in English, strong analytical abilities, and attention to detail.
- Experience using CMS National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and clinical criteria guidelines.
Nice-to-haves
- Experience working in a startup or high-growth company environment.
- Familiarity with collaborating in diverse, global teams.
- Proficiency with Mac computers.
- Certified Professional Coder (CPC) certification in addition to CCS.
Compensation & Benefits
- Salary range: $125,000 - $140,000 annually.
- Fully remote position with approximately 10% travel.
- Medical, dental, vision, life, and disability insurance.
- Employee Assistance Program.
- 401(k) retirement plan with company match.
- Flexible spending and health savings accounts.
- Flexible time off plus company holidays.
- Up to 14 weeks of paid parental leave.
- Pet insurance.
Compensation decisions are based on qualifications, experience, skillset, and internal alignment.
Interview Process
- Preliminary phone screening with Talent Acquisition.
- Interview with Hiring Manager.
- Case assessment.
- Behavioral interviews.
Process is subject to change.
Location
Fully remote position; approximately 10% travel required.