Remote Outpatient Audit Manager | Leadership & Analytics

Embedded Shishya; United States; Remote; USD 105,000 - 115,000; Full time

Job summary

Embedded Shishya is seeking a senior auditor manager for a 100% remote, U.S.-based role. You will lead the audit team responsible for outpatient payment integrity, covering facility, ambulatory surgery, ED, observation, and professional claims.

The ideal candidate will demonstrate strong leadership and analytical skills, with expertise in CPT, HCPCS, NCCI edits, CMS outpatient reimbursement methodologies, and payer-specific billing requirements.

Qualifications

• Experience managing audit teams and directing payment integrity reviews.
• Strong leadership and analytical capabilities with attention to detail.
• Expertise in CPT/HCPCS coding and payer-specific rules.

Responsibilities

• Directly manage auditors responsible for outpatient payment integrity reviews.
• Oversee audits of outpatient facility, ambulatory surgery, ED and professional claims.
• Ensure adherence to CMS reimbursement methodologies and NCCI edits.

Skills

Leadership

Auditor leadership

CPT

HCPCS

NCCI edits

CMS outpatient billing

Job description

Embedded Shishya is seeking a senior auditor manager for a 100% remote, U.S.-based role. You will lead the audit team responsible for outpatient payment integrity, covering facility, ambulatory surgery, ED, observation, and professional claims.

The ideal candidate will demonstrate strong leadership and analytical skills, with expertise in CPT, HCPCS, NCCI edits, CMS outpatient reimbursement methodologies, and payer-specific billing requirements.