Director of Internal Audit

Jobtailor; Kearny (NJ); On-site; USD 120,000 - 180,000; Full time

Job summary

Jobtailor seeks an experienced Healthcare Internal Audit Leader to design and run monthly audits across providers, focusing on credentialing, enrollment, licensure, and compliance with Medicaid and commercial payer rules.

You will verify billing accuracy, review clinical documentation for medical necessity, and drive process improvements with executives. This role requires strong communication and the ability to build scalable audit functions.

Qualifications

• Bachelor's degree in accounting, healthcare administration, nursing, or related field.
• 8+ years in healthcare internal audit, compliance, or payer audit functions.
• Experience scaling an audit or compliance function is highly preferred.

Responsibilities

• Design monthly audit methodology with sampling, testing, and documentation standards.
• Select samples and execute audit testing across providers and states.
• Verify credentialing, enrollment, licensure, and state registration compliance.
• Review HR files for sampled providers and client files for completeness.
• Review authorizations, referrals, and CDEs; assess medical necessity.
• Provide executive reporting on audit outcomes and risks.
• Own responses to payer records requests and billing audits.
• Lead internal audit team structure, staffing, and workflows.

Skills

Audit Methodology Design

Clinical Documentation Review

Billing and Coding Accuracy

Sampling Approach Development

Testing Procedures

Root-Cause Analysis

Executive Reporting

Education

Bachelor's Degree in Accounting

Healthcare Administration

Nursing

Internal Audit Certifications

Tools

Central Reach

ABA Practice Management Systems

Billing QA Tools

Job description

• Design the monthly audit methodology, including sampling approach, testing procedures, and documentation standards
• Select representative monthly samples of providers across states and payers and execute audit testing
• Verify provider credentialing, payer enrollment, licensure, and state registration compliance
• Review HR file completeness for sampled BCBA and BT/RBT providers
• Verify client file completeness, including signed handbooks, intake forms, and financial responsibility agreements
• Verify authorizations, referrals, and CDEs
• Review billing and coding accuracy and assess whether prebilling QA and reviewer follow-up processes function effectively
• Assess clinical documentation and medical necessity, including review and correction of NoteGuardAI clinical flags before billing
• Partner with process owners to turn audit findings into organizational improvements
• Provide executive reporting on audit outcomes, risk, quality, and areas requiring leadership attention
• Track issues to root-cause resolution across audit cycles
• Own responses to payer-initiated records requests and billing audits
• Review audit submissions for completeness, accuracy, and risk before deadlines
• Coordinate final approval and secure submission to payers
• Support responses to recoupment or adverse audit findings and coordinate appeal documentation
• Define the internal audit team structure, staffing plan, and workflows
• Recruit, hire, train, and manage audit staff
• Establish quality-control and review processes
• Refine audit scope and testing procedures as regulations, payer requirements, and risks evolve

Requirements

• 8+ years of progressive experience in healthcare internal audit, compliance, or regulatory/payer audit functions
• Prior experience building or scaling an audit or compliance function strongly preferred
• Working knowledge of Medicaid and commercial payer billing requirements
• ABA, behavioral health, or other therapy-services billing experience is a significant plus
• Demonstrated experience reviewing clinical documentation for medical necessity
• Demonstrated experience evaluating provider credentialing/licensure compliance
• Track record of managing or coordinating high-stakes, deadline-driven external audit or records-request processes with a payer, regulator, or accreditation body
• Ability to operate as an individual contributor initially, with strategic judgment and leadership instincts to design and grow a function
• Strong written communication skills
• Ability to produce clear, defensible audit findings and executive-level reporting
• Bachelor's degree in accounting, healthcare administration, nursing, or related field; or certifications in internal audit
• Experience with Central Reach or comparable ABA practice management/EHR systems preferred
• Experience with payer billing QA/flagging tools preferred
• Experience operating under a dual reporting structure and partnering with compliance and legal stakeholders preferred

Core Competencies

Demonstrates extensive experience in healthcare internal audit and compliance, with a strong focus on Medicaid and commercial payer billing requirements. Capable of producing clear audit findings and executive-level reporting while managing high-stakes audit processes.

Highest-signal resume keywords

• Healthcare Internal Audit Experience
• Medicaid Billing Requirements
• Provider Credentialing Compliance
• Executive Reporting Skills
• Audit Function Development

ATS Optimization Keywords

Hard Skills

• Audit Methodology Design
• Clinical Documentation Review
• Billing and Coding Accuracy Assessment
• Sampling Approach Development
• Testing Procedures Implementation
• Quality Control Processes
• Root-Cause Analysis
• Regulatory Compliance Assessment
• Payer Enrollment Verification
• Licensure Compliance Verification

Soft Skills

• Strong Written Communication
• Strategic Judgment
• Leadership Instincts

Certifications & Qualifications

• Bachelor's Degree in Accounting
• Healthcare Administration
• Nursing
• Internal Audit Certifications

Industry Keywords

• Behavioral Health Billing
• Audit Submissions
• Payer Records Requests
• Compliance Functions
• Accreditation Body Coordination

Tools & Technologies

• Central Reach
• ABA Practice Management Systems
• Billing QA Tools