Team Lead, Auditing

This role leads a team of auditors within a high-growth Payment Integrity environment, overseeing comprehensive reviews across inpatient, outpatient, and professional claims.
You will combine people leadership with deep expertise in coding, DRG auditing, reimbursement accuracy, and overpayment identification.
The position plays a key role in maintaining audit quality, meeting productivity targets, and supporting accurate and compliant reimbursement outcomes.
You will collaborate cross-functionally, mentor auditors, and help establish efficient workflows while maintaining rigorous standards.
The role requires strong analytical judgment, attention to detail, and the ability to interpret complex clinical and coding information.
You will also stay current with evolving coding guidelines, reimbursement trends, and healthcare payment policies.
This is a fully remote opportunity suited to an experienced auditing leader who values precision, collaboration, continuous learning, and measurable impact.

• 8+ years of experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or payer.
• 2–3 years of supervisory or management experience, including experience supervising and training teams in a remote work environment.
• CCS certification is highly preferred.
• RHIA or RHIT certification preferred, along with an Associate’s Degree in Health Information Management, Nursing, or a related field.
• Preference for candidates who hold both a coding credential and an HIM credential such as RHIA or RHIT.
• Advanced expertise in ICD-10-CM/PCS coding, with the ability to exercise sound professional judgment when evaluating complex clinical information, validating diagnosis assignments, and identifying coding discrepancies or upcoding.
• Strong knowledge of CMS NCDs/LCDs and clinical criteria guidelines.
• Demonstrated ability to develop well-supported audit findings using authoritative coding and regulatory references.
• Ability to work independently and remain highly productive in a fully remote environment while managing priorities and workflow autonomously.
• Strong analytical, written, and verbal communication skills, with exceptional attention to detail.
• Passion for DRG auditing, teamwork, collaboration, and continuous professional development.
• Experience in outpatient and professional claims auditing is preferred.
• Experience working in a startup or high-growth environment, demonstrating agility and adaptability.
• Comfortable collaborating with diverse, globally distributed teams.
• Strong computer skills and familiarity with Mac systems.
• Ability to travel approximately 5%, including potential travel to Boston, MA for onsite onboarding and occasional in-person team meetings.
• Must be legally authorized to work in the United States; immigration sponsorship is not indicated for this position.