Senior Manager, Clinical & Coding Audit (Remote)

Health Business Solutions; United States; Remote; USD 120,000 - 180,000; Full time

Job summary

Health Business Solutions (HBiz) is seeking an experienced Senior Manager, Clinical & Coding to lead and oversee clinical and coding operations across government and commercial payers, including post-pay audit. This role focuses on managing end-to-end audit activities, ensuring regulatory compliance, and optimizing financial outcomes for our clients in a remote environment.

The ideal candidate is a strong people leader with deep expertise in clinical validation, coding compliance, and post-pay

Qualifications

• 7+ years in healthcare auditing with focus on clinical and coding post-pay audits.
• Bachelor’s degree in Nursing.
• 1+ year of people leadership with training and coaching responsibilities.
• Experience with CMS regulations, coding guidelines, and payer audit processes.
• Credentials such as RHIA, RHIT, CCS, CPC, CPMA, or RN preferred.

Responsibilities

• Lead and oversee clinical and coding audits for government and commercial payers.
• Direct audit intake, medical record review, clinical validation, and coding accuracy assessments.
• Ensure audits comply with CMS regulations and payer policies.
• Manage and mentor audit teams including onshore and offshore resources.
• Present audit performance reports and executive summaries.
• Support rebuttals, appeals, and education initiatives as needed.
• Lead DRG denial reviews and maximize reimbursement recovery.

Skills

People leadership

CMS regulations knowledge

Clinical & coding audits

Regulatory compliance

Education

Bachelor’s degree in Nursing

Tools

Audit tracking systems

Electronic Health Records

Performance dashboards

Job description

Health Business Solutions (HBiz) is seeking an experienced Senior Manager, Clinical & Coding to lead and oversee clinical and coding operations across government and commercial payers, including post-pay audit. This role focuses on managing end-to-end audit activities, ensuring regulatory compliance, and optimizing financial outcomes for our clients in a remote environment.

The ideal candidate is a strong people leader with deep expertise in clinical validation, coding compliance, and post-pay