This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Team Lead, Auditing based in United States.
This role leads a team of auditors within a high-growth Payment Integrity environment, overseeing comprehensive reviews across inpatient, outpatient, and professional claims.
You will combine people leadership with deep expertise in coding, DRG auditing, reimbursement accuracy, and overpayment identification.
The position plays a key role in maintaining audit quality, meeting productivity targets, and supporting accurate and compliant reimbursement outcomes.
You will collaborate cross-functionally, mentor auditors, and help establish efficient workflows while maintaining rigorous standards.
The role requires strong analytical judgment, attention to detail, and the ability to interpret complex clinical and coding information.
You will also stay current with evolving coding guidelines, reimbursement trends, and healthcare payment policies.
This is a fully remote opportunity suited to an experienced auditing leader who values precision, collaboration, continuous learning, and measurable impact.
Accountabilities:
- Lead, mentor, and support a team of auditors, managing workloads, priorities, performance, and professional development.
- Coordinate with cross-functional teams to align on production goals, quality reviews, workflows, and required timelines.
- Conduct comprehensive coding and DRG reviews to validate accuracy, reimbursement, diagnosis assignments, and potential overpayments.
- Apply advanced knowledge of coding guidelines and industry tools to identify payment integrity opportunities and improve audit efficiency.
- Prepare clear, concise, and well-supported audit findings using authoritative references such as AHA Coding Clinic guidance and ICD-10-CM/PCS regulations.
- Use advanced DRG encoder tools to support accurate and efficient auditing.
- Meet or exceed established quality and productivity standards, including strong uphold rates for appeals.
- Maintain current knowledge of coding updates, compliance requirements, reimbursement trends, and healthcare payment policies.
- Ensure adherence to HIPAA requirements and applicable policies and procedures for data security and regulatory compliance.
- Support inpatient audits involving case-rate and per-diem reimbursement, with additional exposure to outpatient and professional claims auditing as applicable.
Requirements
- 8+ years of experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or payer.
- 2–3 years of supervisory or management experience, including experience supervising and training teams in a remote work environment.
- CCS certification is highly preferred.
- RHIA or RHIT certification preferred, along with an Associate’s Degree in Health Information Management, Nursing, or a related field.
- Preference for candidates who hold both a coding credential and an HIM credential such as RHIA or RHIT.
- Advanced expertise in ICD-10-CM/PCS coding, with the ability to exercise sound professional judgment when evaluating complex clinical information, validating diagnosis assignments, and identifying coding discrepancies or upcoding.
- Strong knowledge of CMS NCDs/LCDs and clinical criteria guidelines.
- Demonstrated ability to develop well-supported audit findings using authoritative coding and regulatory references.
- Ability to work independently and remain highly productive in a fully remote environment while managing priorities and workflow autonomously.
- Strong analytical, written, and verbal communication skills, with exceptional attention to detail.
- Passion for DRG auditing, teamwork, collaboration, and continuous professional development.
- Experience in outpatient and professional claims auditing is preferred.
- Experience working in a startup or high-growth environment, demonstrating agility and adaptability.
- Comfortable collaborating with diverse, globally distributed teams.
- Strong computer skills and familiarity with Mac systems.
- Ability to travel approximately 5%, including potential travel to Boston, MA for onsite onboarding and occasional in-person team meetings.
- Must be legally authorized to work in the United States; immigration sponsorship is not indicated for this position.
Benefits
- Annual salary range of $100,000–$110,000, with total compensation also including bonus and benefits.
- Fully remote work opportunity.
- Approximately 5% travel.
- Medical, dental, and vision insurance.
- Life and disability insurance.
- Employee Assistance Program.
- 401(k) retirement plan with company match.
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
- Flexible Time Off and company holidays.
- Up to 14 weeks of paid parental leave.
- Pet insurance.
- Opportunity to lead and develop an auditing team while contributing to payment integrity and reimbursement accuracy initiatives.
- Collaborative, growth-oriented environment with exposure to healthcare technology, analytics, and evolving payment integrity practices.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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