Outpatient Auditor Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Direct the implementation and ongoing enhancement of outpatient audit programs.

• Supervise daily audit operations to ensure compliance with client SLAs, maintain quality standards, achieve productivity objectives, and meet turnaround times.

• Oversee inventory management, workflow allocation, aging processes, and throughput metrics.

• Provide leadership, coaching, feedback, and development opportunities for outpatient auditors and team leads.

• Track productivity, quality, and turnaround metrics while executing corrective measures as needed.

• Guarantee that audits adhere to CMS regulations, NCCI guidelines, payer policies, and coding and billing standards.

• Assist in the onboarding of new clients, audit initiatives, workflow modifications, and system upgrades.

• Perform quality assessments and pinpoint trends that necessitate education, clarification, or process enhancements.

• Create and present training sessions on outpatient coding, reimbursement, audit methodologies, and payer requirements.

• Recognize operational risks, escalate concerns, and facilitate prompt resolutions.

• Compile and present reports on productivity, quality, inventory, aging, and audit results.

• Aid in client meetings, reporting inquiries, and discussions regarding audit strategies.

• Support workforce planning, recruitment, onboarding, performance management, and talent development.

⛳️ Requirements

• Bachelor's Degree.

• Five to eight years of experience in outpatient coding, auditing, payment integrity, revenue cycle, or healthcare reimbursement operations.

• Preferred coding credentials include RHIT, RHIA, CCS, CPC, COC, or equivalent.

• Extensive knowledge of CPT, HCPCS, revenue codes, modifier applications, NCCI edits, APC reimbursement methodologies, and outpatient billing regulations.

• Familiarity with Medicare, Medicaid, and commercial payer policies.

• Previous experience in leading teams or holding supervisory roles within a production-oriented environment.

• Experience in healthcare audit operations, payment integrity programs, or claims review functions.

• Strong analytical and problem-solving capabilities.

• Proficient in interpreting clinical documentation, coding guidelines, and reimbursement criteria.

• Competence in Microsoft Office applications and healthcare audit or reporting systems.

• Ability to oversee audit workflows and team performance to achieve operational goals.

• Skill in analyzing data, identifying risks and trends, and formulating effective action plans.

• Exceptional leadership, coaching, and team development abilities.

• Proficient in collaborating with clinical, coding, operational, client-facing, and technical teams.

• Capability to support process enhancements, workflow improvements, and program implementations.

• Strong organizational, prioritization, and time management skills.

• Ability to cultivate relationships and foster positive interactions with team members and clients.

• Willingness to complete a brief coding/auditing assessment during the interview process.

🏝️ Benefits

• Healthcare, vision, and dental insurance.

• 401(k) options available.

• Opportunities for professional development.

• A culture that promotes collaboration, support, and inclusion.

• Up to 10% annual travel for team meetings and limited client onsite engagements.

• A fast-paced, innovative environment with industry-leading experts.

• Practical experience supporting prominent healthcare clients.