Director, Post Pay Audit

Health Business Solutions LLC; Town of Florida (NY); Hybrid; USD 180,000 - 240,000; Full time

Job summary

A healthcare consulting firm is looking for an experienced Director of Post-Pay Audit to lead audit teams in both U.S. and Philippines operations. The role involves overseeing comprehensive post-payment audits for various payers, ensuring compliance and maximizing revenue recovery. Candidates should have significant experience in healthcare reimbursement policies and government audit programs. Leadership of cross-functional teams is crucial for this position, along with a strong understanding of healthcare billing and coding systems.

Qualifications

• Minimum of 7–10 years of experience in post-payment auditing, healthcare reimbursement, or revenue recovery.
• Proven experience managing global teams, including operations based in the Philippines.
• Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits).
• Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies.
• Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies.

Responsibilities

• Lead and manage the end-to-end post-pay audit function.
• Direct and support a global team of audit professionals.
• Oversee audit processes related to government payers.
• Collaborate with compliance, legal, and analytics teams.
• Build relationships with internal stakeholders and clients.
• Serve as the subject matter expert for payer audit guidelines, CMS regulations, and state-specific requirements.
• Build strong relationships with internal stakeholders and clients to align audit strategies with broader revenue recovery goals.
• Develop and execute training programs and professional development plans for onshore and offshore audit staff.
• Ensure adherence to internal quality standards, HIPAA regulations, and client-specific SLAs.
• Analyze audit outcomes and present regular performance and risk reports to senior leadership.

Skills

Leadership

Analytical skills

Communication

Knowledge of healthcare reimbursement

Process improvement

Education

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

Master’s or MBA

Tools

Audit and recovery systems

Reporting tools

Workflow platforms

Job description

Job Summary

We are seeking a highly experienced and strategic Director of Post-Pay Audit to lead our medical revenue recovery audit teams across both onshore (U.S.) and offshore (Philippines) operations. This leader will be responsible for overseeing the execution of comprehensive post-payment audits across commercial and government payers (Medicare, Medicaid, TRICARE, etc.), ensuring compliance, accuracy, and maximum revenue recovery for healthcare provider clients.

The ideal candidate brings deep knowledge of healthcare reimbursement policies, government audit programs (e.g., RAC, UPIC, MAC), and a proven ability to lead cross-functional and cross-cultural teams at scale.

Key Responsibilities

• Lead and manage the end-to-end post-pay audit function, including planning, execution, quality assurance, and reporting.
• Direct and support a global team of audit professionals, ensuring productivity, accuracy, and compliance across both U.S.-based and Philippines-based operations.
• Oversee audit processes related to government payers and regulatory programs (e.g., CMS RAC, Medicaid Integrity Program, etc.).
• Establish and refine audit workflows, KPIs, and escalation protocols to optimize audit yield and recovery timelines.
• Collaborate with compliance, legal, and analytics teams to identify audit opportunities and mitigate risk.
• Serve as the subject matter expert for payer audit guidelines, CMS regulations, and state-specific requirements.
• Build strong relationships with internal stakeholders and clients to align audit strategies with broader revenue recovery goals.
• Develop and execute training programs and professional development plans for onshore and offshore audit staff.
• Ensure adherence to internal quality standards, HIPAA regulations, and client-specific SLAs.
• Analyze audit outcomes and present regular performance and risk reports to senior leadership.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required; Master’s or MBA preferred
• Minimum of 7–10 years of experience in post-payment auditing, healthcare reimbursement, or revenue recovery
• Proven experience managing global teams, including operations based in the Philippines
• Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits)
• Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies
• Demonstrated ability to lead process improvement initiatives in large-scale audit operations
• High proficiency with audit and recovery systems, reporting tools, and workflow platforms
• Strong communication, leadership, and analytical skills
• Certification in auditing, billing, or compliance (e.g., CPMA, CPC, CHC) is a plus

Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

HBiz complies with all applicable employment laws for remote and multi-state hiring and provides reasonable accommodations as required by law.