Manager, Government Audit

Position Summary:

HBiz is seeking an experienced and highly organized Manager of Audit to lead all audit-related operations across government, commercial, and post-payment audits. This fully remote role will report directly to the VP of Clinical Appeals and is responsible for overseeing end-to-end audit processes, ensuring regulatory compliance, and managing a team that includes offshore staff. The ideal candidate is a strong communicator, detail-oriented, and comfortable working flexible hours to support coordination across global teams and time zones.

Key Responsibilities:

• Audit Oversight & Lifecycle Management
  • Lead the management and response process for a variety of audits including RAC, MAC, CERT, PERM, TPE, and commercial payer audits.
  • Oversee case intake, documentation collection, quality review, and timely submission.
  • Track and analyze audit trends, denials, and appeal outcomes to identify risks and recommend improvements.
• Reporting & Tracking
  • Maintain detailed audit logs and status reports using audit tracking systems.
  • Develop and deliver regular audit performance dashboards and summaries to leadership.
  • Identify audit trends and provide insights for proactive risk mitigation.
• Team Management & Workflow Coordination
  • Supervise and support a team of audit staff, including managing offshore resources.
  • Assign and coordinate cases with clinical, coding, technical, and documentation teams.
  • Ensure efficient workflows and balanced workloads across team members.
  • Work flexible hours when needed to support offshore operations and tight deadlines.
• Collaboration Across Departments
  • Act as the liaison between clinical, coding, HIM, compliance, and IT teams for audit support.
  • Ensure audit responses include accurate, complete, and compliant documentation.
  • Facilitate escalation and resolution of complex audit issues.
• Compliance & Quality Assurance
  • Ensure all audit activity complies with CMS, commercial payer, and regulatory requirements.
  • Support policy and process development to strengthen audit readiness and response.
  • Participate in internal audits and risk assessments as needed.

Qualifications:

• Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or related field (Master’s preferred).
• Minimum 5 years of healthcare audit experience, including government and post-payment audits.
• At least 2 years in a supervisory or leadership role, including managing remote/offshore staff.
• In-depth understanding of audit regulations, payer requirements, and healthcare reimbursement.
• Familiarity with medical coding (ICD-10, CPT, HCPCS), billing practices, and clinical documentation standards.
• Excellent communication, organizational, and leadership skills.
• Proficient with audit tracking software, EHRs, and Microsoft Office Suite.

The ideal candidate is articulate, organized, detail-oriented, and able to adjust their schedule as needed to engage with teams across a global network and multiple time zones.

Acts as a liaison between internal Hbiz clients, (i.e.: coding, HIM, compliance, and IT teams); as well as external clients we are supporting with our services.