Director, Post Pay Audit, Florida

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.
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