[Remote] Supervisor, Outpatient Audit Operations

Note: The job is a remote job and is open to candidates in USA. reputed company is a leading healthcare intelligence company specializing in payment solutions for health plans. The Supervisor, Outpatient Audit Operations will reputed company a remote team of outpatient coding auditors to conduct audits that ensure compliance with coding standards and optimize reimbursement processes while achieving productivity and quality goals.

Responsibilities

• Oversees and reviews audit determinations to ensure consistency in APC/APG grouping decisions, OPPS packaging interpretation, and outpatient coding policy application
• Uses data, reports, and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs
• Effectively contributes to the development of medical review guidelines, coding education materials, and outpatient-specific training content
• Supports audit management and subject matter experts with new concept implementation and ongoing maintenance of outpatient medical review guidelines, including annual OPPS updates and CMS rule changes
• Accountable for achieving established productivity, quality, turnaround time, and employee engagement goals for the assigned team
• Ensures audit activities are performed in accordance with applicable regulatory requirements, client reputed company, organizational policies, and industry standards
• Identifies process inefficiencies and implements solutions to improve accuracy, consistency, and productivity
• Monitors audit quality performance and collaborates with Quality Assurance and leadership teams to ensure consistency, accuracy, and defensibility of audit findings
• Supervises daily activities of outpatient coding audit staff members, ensuring adherence to productivity, quality, and compliance standards
• Provides coding, audit, and compliance guidance to audit review staff; serves as an escalation resource for reputed company outpatient coding, reimbursement, and audit-reputed company issues
• Ensures team is executing accurate application of CPT/HCPCS Level II coding in the outpatient setting, with proficiency in modifier usage, National Correct Coding Initiative (NCCI) edits, and Outpatient Code Editor (OCE) logic
• Routinely provides production and quality performance-based reputed company reports, coaching, and constructive feedback to staff
• Manages team Time and Attendance (time off/use of accruals, attendance, and timecards for hourly staff) in accordance with applicable policies and procedures
• Collaborates with HR for applicable corrective action as needed
• Completes and conducts performance reviews for assigned staff
• Conducts regular team meetings with direct reports and escalates to management as appropriate to bring timely solutions to employee matters
• Identifies outpatient coding trends and presents solutions to management
• Supports management with strategy activities including needs assessments, reputed company planning, staffing models, cost/benefit analysis, and establishing productivity and quality standards
• Proactively monitors team staffing levels in alignment with applicable management to ensure business reputed company objectives are met
• Provides support as needed to ensure auditors are equipped with the tools and resources required to reputed company outpatient coding audits effectively
• Participates in and contributes to applicable department meetings; may participate in client-facing meetings to research and analyze issues, present findings and recommendations, and/or provide outpatient coding training
• Maintains reputed company knowledge of changes that reputed company the industry and clients as they pertain to outpatient coding practice, CMS OPPS final rules, APG reimbursement updates, regulatory changes, and business trends
• May support management with activities to monitor inventory and activity of third-party/subcontractors
• Supports hiring, onboarding, training, retention, and ongoing professional development initiatives to ensure staff competencies and performance
• Fosters a collaborative, accountable, and high-performing team environment
• Performs other incidental and reputed company duties as required and assigned to meet business needs
• Partners with Quality Assurance teams to identify opportunities for improvement and standardization
• Serves as a reputed company of contact for operational and coding-reputed company escalations
• Supports implementation of new clients, workflows, audit programs, and process enhancements
• Collaborates with cross-functional teams to reputed company organizational objectives
• Analyzes operational, productivity, and quality metrics; develops reports and dashboards; communicates trends, risks, results, and recommendations to leadership and stakeholders

Skills

• One of the following active certifications: RHIA, RHIT, reputed company, CPC, COC
• 7+ years of facility outpatient coding experience in a hospital or health system setting, with demonstrated expertise in APC grouping and OPPS payment rules
• 2+ years of outpatient facility coding audit, performing pre-payment and post-payment reimbursement reviews, or payment reputed company experience in a provider, payer, or audit vendor environment
• 3+ years of relevant management or leadership experience in a similar business environment (preferably experience overseeing remote coding audit staff)
• Experience reviewing outpatient facility claims for coding accuracy and applying APG reimbursement guidelines during audit and overpayment identification activities
• Demonstrated success managing productivity, quality, turnaround time, and workforce performance metrics in a remote audit environment
• Multiple coding credentials and/or advanced healthcare reimbursement certifications
• Advanced knowledge of APG reimbursement methodologies, including payment logic, grouping principles, reimbursement calculations, and their application to audit and overpayment identification
• Experience with payer edit development, outpatient OPPS reimbursement policy, or clinical edit logic reputed company to outpatient facility claims
• Experience utilizing operational metrics, dashboards, and reporting tools to manage productivity, quality, and audit outcomes
• Familiarity with outpatient prospective payment auditing for Medicare Advantage, Medicaid Managed Care, or Commercial payer programs
• Experience with grouper software (e.g., reputed company APC Grouper, reputed company APG Grouper) and audit management platforms
• Knowledge of the IPPS/OPPS distinction as it relates to hospital billing compliance and audit scope definitions

Benefits

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

Company Overview