Remote Senior Manager, Clinical & Coding Audits

Health Business Solutions LLC; Town of Florida (NY); On-site; USD 120,000 - 180,000; Full time

Job summary

Health Business Solutions LLC is seeking a Senior Manager, Clinical & Coding to lead and oversee clinical and coding audit programs across government and commercial payers in a fully remote capacity. You will manage end-to-end audits, ensure regulatory compliance, and optimize reimbursement for multiple clients.

The role requires strong leadership of audit teams, expertise in ICD-10-CM/PCS, CPT/HCPCS, and post-pay audit methodologies, and collaboration with stakeholders to mitigate risk while

Qualifications

• Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, or a related field.
• 7+ years of progressive experience in healthcare auditing with focus on clinical and coding post-pay audits.
• 1+ years of leadership experience with training, coaching, and performance feedback.
• Experience managing audit teams and complex audit programs.
• Strong knowledge of CMS regulations, official coding guidelines, and payer audit processes.
• Credentials such as RHIA, RHIT, CCS‑P, CPC, CPMA, RN or equivalent.

Responsibilities

• Audit Oversight & Strategy: lead and oversee clinical and coding audits for government and commercial payers.
• Clinical & Coding Expertise: provide SME in ICD-10-CM/PCS, CPT, HCPCS, DRG validation, and documentation integrity.
• Leadership & Team Management: mentor audit teams including onshore/offshore resources.
• Reporting, Analytics & Risk Mitigation: track outcomes, develop dashboards, present executive summaries.
• Client & Stakeholder Collaboration: serve as senior point of contact for clients and proposals.
• Lead DRG denial reviews and appeals to maximize reimbursement and reduce future denials.

Skills

Analytical skills

Communication skills

Presentation skills

Remote project management

Detail-oriented

Leadership

Education

Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, or related field

Tools

Audit tracking systems

EHRs

Performance dashboards

Job description

Health Business Solutions LLC is seeking a Senior Manager, Clinical & Coding to lead and oversee clinical and coding audit programs across government and commercial payers in a fully remote capacity. You will manage end-to-end audits, ensure regulatory compliance, and optimize reimbursement for multiple clients.

The role requires strong leadership of audit teams, expertise in ICD-10-CM/PCS, CPT/HCPCS, and post-pay audit methodologies, and collaboration with stakeholders to mitigate risk while