Team Lead, Auditing
Core
Lead a team of auditors to conduct comprehensive reviews of inpatient, outpatient, and professional claims, ensuring coding accuracy and maximizing overpayment identification using AI-driven tools.
Role type
Senior Team Lead, Payment Integrity Auditing
Builds
Accurate reimbursement solutions and payment integrity workflows for healthcare payers and providers
Domain
Healthcare / Medical Coding / Payment Integrity
Deliverable
production ML models | product features
Required skills
MS-DRG and ARP-DRG review, ICD-10-CM/PCS coding, CMS NCDs/LCDs application, team leadership, audit finding documentation, DRG encoder tools, HIPAA compliance
Preferred skills
CCS credential, RHIA or RHIT credential, inpatient case rate/per diem auditing, outpatient/professional claims auditing, startup environment experience
Technologies
DRG encoder tools, Mac, Cohere Validate
Responsibilities
Lead and mentor a team of auditors, conduct comprehensive coding reviews, craft clear audit findings backed by AHA Coding Clinic Guidelines, stay ahead of industry trends and coding updates, adhere to HIPAA and company policies
Seniority
Senior, hands-on IC with management responsibilities