Senior Manager Auditing (Healthcare)

TL;DR

Senior Manager Auditing (Healthcare): Lead DRG, Professional, and Outpatient audit teams delivering quality control for AI-powered healthcare payment validation with an accent on compliance, coding accuracy, and performance metrics. Focus on conducting audits, resolving provider disputes, and applying updates to coding guidelines and reimbursement policies.

Location: Fully remote (United States) with about 10% travel

Salary: $125,000 - $140,000 annually

Company

hirify.global’s clinical intelligence platform delivers AI-powered solutions that streamline payer-provider collaboration, cost containment, and healthcare economics, handling millions of prior authorization requests.

What you will do

• Lead and manage DRG, Professional, and Outpatient audit teams, coordinating onboarding and training.
• Perform audits, quality reviews, and provider dispute audits ensuring compliance with coding guidelines and client requirements.
• Generate quality and quantity reports on team performance to meet operational objectives.
• Handle hiring, interviews, and ongoing team education and support.
• Collaborate with internal teams and potentially clients to align on performance expectations.
• Maintain expertise in coding guideline changes, reimbursement trends, and health payment policies.

Requirements

• Bachelor’s degree.
• 10+ years of Inpatient coding, auditing, and quality review experience in payment integrity.
• 3+ years of supervisory/management experience, including in remote environments.
• CCS (Certified Coding Specialist) credential.
• Superior knowledge of ICD-10-CM/PCS, MS-DRG/APR-DRG, and US healthcare payment methodologies (Commercial, Marketplace, Medicare, Medicaid).
• Excellent written and verbal English communication skills; strong analytical skills and attention to detail.
• Experience using CMS NCDs/LCDs and clinical criteria guidelines.

Nice to have

• Experience in a start-up or high-growth company.
• Familiarity with diverse, global teams.
• Excellent computer skills, including Mac.
• CPC certification in addition to CCS.

Culture & Benefits

• Fully remote with 10% travel; Flex Time Off + company holidays; up to 14 weeks paid parental leave.
• Medical, dental, vision, life, disability insurance, EAP, pet insurance.
• 401K with company match; flexible spending and health savings accounts.
• Supportive, growth-oriented environment valuing curiosity, collaboration, impact, diversity, and inclusion.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Meeting with Hiring Manager.
• Case Assessment.
• Behavioral Interview(s).