Remote Government & Payer Audit Manager

Position Summary: HBiz is seeking an experienced and highly organized Manager of Audit to lead all audit-related operations across government, commercial, and post-payment audits. This fully remote role will report directly to the VP of Clinical Appeals and is responsible for overseeing end-to-end audit processes, ensuring regulatory compliance, and managing a team that includes offshore staff . The ideal candidate is a strong communicator, detail-oriented, and comfortable working flexible hours to support coordination across global teams and time zones. Key Responsibilities: Audit Oversight & Lifecycle Management Lead the management and response process for a variety of audits including RAC, MAC, CERT, PERM, TPE, and commercial payer audits. Oversee case intake, documentation collection, quality review, and timely submission. Track and analyze audit trends, denials, and appeal outcomes to identify risks and recommend improvements. Reporting & Tracking Maintain detailed audit logs and status reports using audit tracking systems. Develop and deliver regular audit performance dashboards and summaries to leadership. Identify audit trends and provide insights for proactive risk mitigation. Team Management & Workflow Coordination Supervise and support a team of audit staff, including managing offshore resources. Assign and coordinate cases with clinical, coding, technical, and documentation teams. Ensure efficient workflows and balanced workloads across team members. Work flexible hours when needed to support offshore operations and tight deadlines. Collaboration Across Departments Act as the liaison between clinical, coding, HIM, compliance, and IT teams for audit support. Ensure audit responses include accurate, complete, and compliant documentation. Facilitate escalation and resolution of complex audit issues. Compliance & Quality Assurance Ensure all audit activity complies with CMS, commercial payer, and regulatory requirements. Support policy and process development to strengthen audit readiness and response. Participate in internal audits and risk assessments as needed. Qualifications: Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or related field (Master’s preferred). Minimum 5 years of healthcare audit experience, including government and post-payment audits. At least 2 years in a supervisory or leadership role, including managing remote/offshore staff. In-depth understanding of audit regulations, payer requirements, and healthcare reimbursement. Familiarity with medical coding (ICD-10, CPT, HCPCS), billing practices, and clinical documentation standards. Excellent communication, organizational, and leadership skills. Proficient with audit tracking software, EHRs, and Microsoft Office Suite. The ideal candidate is articulate, organized, detail-oriented, and able to adjust their schedule as needed to engage with teams across a global network and multiple time zones. Acts as a liaison between internal Hbiz clients, (i.e.: coding, HIM, compliance, and IT teams); as well as external clients we are supporting with our services. #J-18808-Ljbffr Health Business Solutions LLC