Supervisor, Outpatient Audit Operations (Healthcare)

TL;DR

Supervisor, Outpatient Audit Operations (Healthcare): Leading a remote team of outpatient coding auditors to conduct pre-payment and post-payment reimbursement audits with an accent on APC/APG grouping, OPPS compliance, and audit accuracy. Focus on operational excellence, capacity planning, and ensuring defensible audit outcomes in alignment with regulatory requirements.

Location: Remote - US

Company

hirify.global is a leading healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and drive down healthcare costs for health plans.

What you will do

• Oversee and review audit determinations to ensure consistency in coding policy application and reimbursement accuracy.
• Supervise daily activities of audit staff, providing guidance on complex coding, reimbursement, and compliance issues.
• Monitor productivity, quality, and turnaround time metrics to ensure business objectives and SLAs are met.
• Collaborate with management on capacity planning, staffing models, and strategic resource allocation.
• Develop and maintain medical review guidelines, training content, and process improvements.
• Partner with Quality Assurance teams to identify opportunities for standardization and performance improvement.

Requirements

• Must be based in the US
• Active certification required: RHIA, RHIT, CCS, CPC, or COC
• 7+ years of facility outpatient coding experience in a hospital or health system setting
• 2+ years of outpatient facility coding audit or payment integrity experience
• 3+ years of management or leadership experience, preferably overseeing remote teams
• Comprehensive knowledge of CMS OPPS, APC grouping, APG methodology, and NCCI edits

Nice to have

• Advanced knowledge of APG reimbursement methodologies and clinical edit logic
• Experience with grouper software such as 3M or Optum
• Familiarity with Medicare Advantage, Medicaid Managed Care, or Commercial payer programs

Culture & Benefits

• Comprehensive health, vision, and dental coverage
• 401(k) plan participation with company match
• Paid Time Off, Paid Holidays, and Volunteer Days
• Tuition reimbursement program
• Company-paid life insurance, short-term disability, and parental leave
• Flexible remote and hybrid work options