Team Lead, Auditing
Core
Lead a team of auditors in a high-growth Payment Integrity environment, overseeing comprehensive reviews across inpatient, outpatient, and professional claims to ensure reimbursement accuracy and identify overpayments.
Role type
Senior IC Team Lead, Auditing (Payment Integrity)
Builds
Accurate reimbursement outcomes and compliant payment integrity workflows for healthcare payers/providers
Domain
Healthcare + Payment Integrity
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
MS-DRG and ARP-DRG review, ICD-10-CM/PCS coding, CMS NCDs/LCDs knowledge, DRG encoder tools, audit findings preparation, HIPAA compliance, team mentorship, workflow optimization
Preferred skills
CCS certification, RHIA or RHIT certification, outpatient/professional claims auditing experience, startup/high-growth environment experience
Technologies
DRG encoder tools, Mac systems
Responsibilities
Lead, mentor, and support a team of auditors managing workloads and performance; Conduct comprehensive coding and DRG reviews to validate accuracy and identify overpayments; Prepare clear, well-supported audit findings using authoritative references; Meet or exceed established quality and productivity standards; Maintain current knowledge of coding updates and healthcare payment policies; Ensure adherence to HIPAA requirements and data security policies.
Seniority
Senior, hands-on IC with supervisory experience