Clinical Audit Solutions Lead

Job Summary

Working remotely in a full-time capacity, the Complex Clinical Audit Business Solutions Lead will translate payment integrity audit knowledge into scalable product capabilities, supporting pre-pay and post-pay programs while collaborating with various stakeholders to enhance product accuracy and efficiency.

Key responsibilities

• Serve as the primary operational subject matter expert for payment integrity methodologies and audit programs
• Translate payer pain points and operational workflows into product capabilities and define audit concepts across priority domains
• Partner with engineering to develop high-performing, reliable AI solutions and support roadmap prioritization and customer expansion

Required qualifications

• 5-10+ years of experience in Payment Integrity, healthcare audit, clinical operations, or healthcare technology product management
• Deep knowledge of U.S. healthcare payer payment integrity programs and audit strategies
• 3+ years in a PI-domain leadership role, such as audit operations or PI program management
• Strong analytical skills with experience in hit-rate analysis and ROI modeling
• Familiarity with claims processing, provider billing, and healthcare interoperability standards