Prepayment Auditing Manager

Job Summary

Managing the daily operations of prepayment claims auditing programs, the full-time Prepayment Auditing Manager will lead a multidisciplinary team to ensure payment accuracy, vendor compliance, and effective audit strategies while working remotely from Pennsylvania.

Key Responsibilities

• Oversee prepayment claim review processes and vendor management to optimize audit performance and compliance
• Develop and implement auditing strategies that align with organizational payment integrity objectives and regulatory requirements
• Manage the audit appeal process, ensuring timely resolutions and collaboration with internal and external stakeholders

Required Qualifications

• Bachelor's Degree in a relevant field or equivalent experience
• 5+ years of experience in Payment Integrity, Claims Auditing, or Healthcare Compliance
• 3+ years of leadership experience managing clinical or auditing teams
• Experience with prepayment review programs and vendor oversight
• Knowledge of healthcare reimbursement methodologies and claims processing