Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder)

TL;DR

Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder): Developing, maintaining, testing, and optimizing payment integrity audit concepts across government and commercial healthcare claim types with an accent on medical coding systems, payment methodologies, and regulatory/client payer policy alignment. Focus on building validated audit concepts, monitoring concept performance with statistical analysis, and resolving discrepancies through cross-functional collaboration.

Location: US

Salary: $80,000 - $120,000

Company

hirify.global provides an AI-powered healthcare intelligence platform used by health plans to improve payment integrity and reduce healthcare costs.

What you will do

• Review and update audit concepts on required cycles and in response to client or regulatory changes, including research, claim/data analysis, and updates to rule documents and code lists.
• Interpret and apply client-specific payer policies and ensure audit concepts are correctly formulated across offering types and program lines.
• Perform QA reviews and validate audit concepts against coding guidelines, payment methodologies, and payer policy prior to deployment.
• Manage multiple concurrent audit concept workflows with high accuracy and ensure consistent policy application across auditing platforms and client programs.
• Monitor concept performance, analyze results to drive scoring/selection, identify trends, and recommend optimizations to improve audit yield and accuracy.
• Create training materials and documentation, and provide subject matter support for client inquiries and internal escalations.

Requirements

• Registered Nurse or Certified Coder credential required (RHIA, RHIT, AHIMA, AAPC, or equivalent).
• Minimum 5+ years of progressive experience in healthcare claim type subject matter, including direct experience in payment integrity and claims auditing.
• Equivalent experience of 3+ years in claims auditing and recovery auditing.
• Demonstrated depth in healthcare coding and payment integrity concepts, including ICD-10-CM, ICD-10-PCS, CPT, HCPCS, HIPPS, and payment methodologies such as MS-DRG, APR-DRG, APC, APG, PDPM, and PDGM.
• Strong analytical and statistical analysis skills to support scoring and selection of audit concepts.
• Proven ability to manage multiple concurrent workflows independently in a remote environment.

Culture & Benefits

• Work from anywhere in the US (digital-first environment).
• Top Medical/Dental/Vision coverage.
• FSA/HSA benefits.
• Tuition reimbursement.
• 401(k) with company match and competitive salary.
• Flexible, trusting environment with support for doing your best work.

Hiring process

• Recruiting team will confirm qualification for the appropriate level and pay range.
• Interviews and evaluations to assess coding/payment integrity expertise and ability to manage complex workflows.