Team Lead, Auditing (Healthcare)

Location: United States; fully remote with approximately 5% travel

Salary: $100,000–$110,000 annually, plus benefits and bonus

Company

A healthcare technology company developing AI-powered clinical intelligence and payment integrity solutions that improve payer-provider collaboration, reduce waste, and support accurate reimbursement.

What you will do

• Lead, mentor, and support the professional development of a team of inpatient, outpatient, and professional auditors.
• Manage workloads, production, quality reviews, priorities, and delivery timelines across the auditing function.
• Conduct comprehensive coding reviews to validate diagnoses, reimbursement accuracy, and potential overpayments.
• Prepare clear, evidence-based audit findings using AHA Coding Clinic guidance and ICD-10-CM/PCS regulations.
• Use DRG encoder tools, CMS NCDs/LCDs, and clinical criteria to improve audit efficiency and accuracy.
• Maintain compliance with HIPAA, company policies, coding updates, reimbursement trends, and healthcare payment regulations.

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 supervising and training staff in a remote work environment.
• Advanced expertise in ICD-10-CM/PCS coding, complex clinical information review, diagnosis validation, and identifying coding errors or upcoding.
• Experience with inpatient case-rate and per-diem audits; outpatient and professional claims auditing experience is preferred.
• Strong written and verbal communication, analytical ability, attention to detail, independent work habits, and organizational skills.
• CCS certification is highly preferred; RHIA or RHIT certification and an associate degree in health information management, nursing, or a related field are preferred.

Nice to have

• Both a coding credential and an HIM credential, such as CCS with RHIA or RHIT.
• Experience in a startup or high-growth environment.
• Experience collaborating with a diverse, global workforce.
• Familiarity with Mac computers.

Culture & Benefits

• Fully remote work with approximately 5% travel.
• Medical, dental, vision, life, disability insurance, and an Employee Assistance Program.
• 401(k) retirement plan with company match, flexible spending account, and health savings account.
• Flexible time off, company holidays, and up to 14 weeks of paid parental leave.
• Pet insurance and a collaborative, inclusive, growth-oriented work environment.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the hiring manager.
• Behavioral interviews.