Audit Team Lead

ADP, Inc.; Town of Florida (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Paradigm is seeking an Audit Team Lead in Miami, FL to guide a team of Audit Specialists reviewing Medicaid and VA accounts for billing accuracy and compliance. You will perform complex audits, mentor staff, and drive process improvements to reduce denials and revenue leakage.

The role requires 5+ years in healthcare revenue cycle with Medicaid/VA experience and strong analytical and communication skills. On-site with hybrid eligibility in the tri-county area.

Qualifications

• 5+ years of healthcare revenue cycle management experience, including at least 3 years of healthcare billing or claims auditing.
• 3+ years of Medicaid reimbursement processes experience; multi-state Medicaid preferred
• 1–2 years of team lead, trainer, or similar peer leadership experience preferred
• Experience with Veterans Affairs (VA) reimbursement and claims processing preferred
• Home care or HCBS billing experience preferred
• Strong understanding of payer reimbursement methodologies and revenue cycle operations
• Working knowledge of HIPAA and healthcare compliance requirements
• Excellent written and verbal communication skills; ability to present audit findings clearly
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
• Proficiency in MS Office Suite (Outlook, Word, Excel)

Responsibilities

• Lead the daily activities of the Audit team, providing guidance and feedback to Audit Specialists and input to the Audit Manager
• Assign, prioritize, and monitor daily audit workloads to meet productivity, turnaround time, and quality standards
• Perform audits of account documentation for accuracy, completeness, and compliance
• Audit billing practices, including multi-state Medicaid billing, for compliance with payer contracts, federal and state regulations (HIPAA)
• Validate reimbursement accuracy and identify sources of revenue leakage
• Audit compliance with payer timely filing requirements
• Review AMS access and usage for remittance advice and claim status
• Onboard, train, and mentor Audit Specialists on revenue cycle management and VA/Medicaid reimbursement
• Identify trends in billing errors and recommend corrective actions
• Document audit findings and prepare reports for management review
• Develop and maintain audit SOPs and department documentation
• Escalate complex findings to Audit Manager as needed
• Foster accountability, collaboration, and client service
• Partner with Billing, Payment Posting, and Collections to improve performance

Skills

Team leadership

Healthcare revenue cycle

Medicaid reimbursement

VA reimbursement

HIPAA knowledge

MS Office proficiency

Analytical skills

Communication

Task prioritization

Education

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Audit Team Lead

Paradigm Full-Time North Miami, FL, US

3 days ago Requisition ID: 1155

Location

Miami, FL (On-site preferred; hybrid eligible within the tri-county area)

Who We Are

At Paradigm, we're revolutionizing home care through innovative technology. As the fastest-growing tech company in this sector, we empower home care agencies with cutting-edge solutions in billing automation, growth education, authorization management, and beyond. We believe that by streamlining agency operations with third-party payers like the Department of Veterans Affairs and Medicaid, we ultimately enhance the quality of care for seniors, veterans, and underserved communities.

We foster a dynamic and collaborative work environment where new ideas are welcome, and creativity thrives. Joining our team means becoming part of a supportive community that values continuous learning and excellence. We're on a mission to revolutionize home care and are looking for passionate individuals to help us make a lasting, positive impact.

Position Snapshot

As the Audit Team Lead, you will guide the daily work of a team of Audit Specialists who review Medicaid and Veterans Affairs (VA) accounts for billing accuracy, reimbursement accuracy, and compliance with federal, state, and payer requirements. As a working lead, you will perform complex audits yourself while assigning and monitoring the team's audit work, serving as the team's subject matter expert and first point of escalation for Medicaid, VA, and payer rules, and turning audit findings into training and process improvements that reduce denials, revenue leakage, and financial risk. This position will report to the Audit Manager.

Core Responsibilities

• Lead the daily activities of the Audit team, providing guidance, coaching, and feedback to Audit Specialists and input to the Audit Manager on performance and development needs
• Assign, prioritize, and monitor daily audit workloads to meet productivity, turnaround time, and quality standards
• Perform audits of account documentation for accuracy, completeness, and compliance
• Audit billing practices, including multi-state Medicaid billing, for compliance with payer contracts, federal and state regulations (including HIPAA), state-specific reimbursement methodologies, and company policies
• Validate reimbursement accuracy and identify sources of revenue leakage
• Audit compliance with payer timely filing requirements
• Review client agency management system (AMS) access and use for retrieving remittance advice (ERAs/EOBs), payment information, and claim status
• Onboard, train, and mentor Audit Specialists on revenue cycle management, Medicaid and VA reimbursement, and audit best practices
• Identify trends in billing errors, denials, underpayments, and overpayments and recommend corrective actions
• Research payer policies and reimbursement guidelines to resolve audit findings and identify opportunities for process improvement
• Document audit findings and prepare accuracy, productivity, and trend reports for management review
• Develop and maintain audit standard operating procedures (SOPs) and departmental documentation
• Serve as the team's first point of escalation for complex audit findings and reimbursement issues, escalating to the Audit Manager as appropriate
• Foster a culture of accountability, collaboration, and client service
• Partner with cross-functional teams, such as Billing, Payment Posting, and Collections, to improve operational performance
• Other duties as assigned

Experience and Skills

• Minimum 5 years of healthcare revenue cycle management experience, including at least 3 years of healthcare billing or claims auditing experience, required
• Minimum 3 years of experience with Medicaid reimbursement processes and regulations required; multi-state Medicaid experience preferred
• At least 1 to 2 years of team lead, trainer, or similar peer leadership experience preferred
• Experience with Veterans Affairs (VA) reimbursement and claims processing preferred
• Home care or home and community-based services (HCBS) billing experience preferred
• Strong understanding of payer reimbursement methodologies and revenue cycle operations, including insurance verification, medical billing, coding validation, claims submission, denial management, and collections
• Working knowledge of HIPAA and healthcare compliance requirements
• Strong analytical skills and attention to detail, with the ability to identify trends and root causes
• Excellent written and verbal communication skills, including the ability to present audit findings clearly to staff and leadership
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
• Proficiency in MS Office Suite (Outlook, Word, Excel) required

Education and Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field preferred