Sr Manager, Post Pay Audit

Manager, Post-Pay Audit

Job Summary:

We are seeking a detail-oriented and driven Post-Pay Audit Manager to lead a team of auditors performing retrospective audits across commercial and government payers. Reporting directly to the Director of Post-Pay Audit, this role is responsible for daily operations management, performance oversight, and quality assurance across onshore and offshore teams , including staff based in the Philippines .

The ideal candidate has experience in medical claims auditing, strong leadership capabilities, and a solid understanding of Medicare, Medicaid, and other payer reimbursement requirements. This position plays a key role in maximizing revenue recovery while ensuring compliance and process excellence.

Key Responsibilities:

• Supervise daily audit operations across onshore and offshore teams , ensuring accuracy, productivity, and timely completion of audit deliverables.
• Provide hands-on leadership, training, and mentorship to audit staff, fostering a high-performance and quality-focused team culture.
• Monitor performance metrics, individual KPIs, and quality assurance results to drive continuous improvement.
• Coordinate the execution of audits for government (RAC, UPIC, MAC) and commercial payers , ensuring adherence to payer policies and audit guidelines.
• Collaborate with the Director of Post-Pay Audit on staffing, planning, and workflow optimization across multiple time zones.
• Conduct regular audit reviews, spot checks, and root cause analysis to ensure compliance and identify patterns of underpayment or denial.
• Escalate complex audit findings or payer discrepancies to senior leadership as needed.
• Assist in the development and implementation of standard operating procedures (SOPs) and training documentation.
• Support audit readiness and documentation for internal and external quality audits.
• Foster strong communication between onshore and offshore teams to ensure alignment on goals and expectations.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Health Information Management, Business, or related field required.
• Minimum of 5years of experience in medical auditing, revenue cycle management, or claims recovery.
• At least 2 years in a supervisory or team lead role , preferably with remote or offshore team management experience.
• Solid knowledge of government audit programs (RAC, MAC, Medicaid Integrity, UPIC) and commercial payer policies.
• Proficiency in healthcare billing, medical coding (ICD-10, CPT, HCPCS), and EOB analysis.
• Strong analytical, organizational, and decision-making skills.
• Experience using audit/recovery software platforms and workflow tools.
• Professional certification preferred (e.g., CPMA, CPC, RHIA, CHC).
• Ability to work cross-functionally in a dynamic, deadline-driven environment.