Machinify logo
Machinify

The future of payment integrity.

Supervisor, Outpatient Audit Operations

OperationsOperationsFull TimeRemoteLeadTeam 1,001-5,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

0

Seniority

Lead

Professional Certificate7 yrs expEnglish

Job Description

Supervisor, Outpatient Audit Operations

Machinify

• 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 contracts, 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.

Job Requirements

  • One of the following active certifications: RHIA, RHIT, CCS, 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 integrity 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.

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

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