Audit Team Lead
North Miami, FL, USA
USD 65k-70k / year
Location
Miami, FL (On-site preferred; hybrid eligible within the tri-county area)
Who We Are
At Paradigm, we're revolutionizing home care through innovative technology. As the fastest-growing tech company in this sector, we empower home care agencies with cutting-edge solutions in billing automation, growth education, authorization management, and beyond. We believe that by streamlining agency operations with third-party payers like the Department of Veterans Affairs and Medicaid, we ultimately enhance the quality of care for seniors, veterans, and underserved communities.
We foster a dynamic and collaborative work environment where new ideas are welcome, and creativity thrives. Joining our team means becoming part of a supportive community that values continuous learning and excellence. We're on a mission to revolutionize home care and are looking for passionate individuals to help us make a lasting, positive impact.
Position Snapshot
As the Audit Team Lead, you will guide the daily work of a team of Audit Specialists who review Medicaid and Veterans Affairs (VA) accounts for billing accuracy, reimbursement accuracy, and compliance with federal, state, and payer requirements. As a working lead, you will perform complex audits yourself while assigning and monitoring the team's audit work, serving as the team's subject matter expert and first point of escalation for Medicaid, VA, and payer rules, and turning audit findings into training and process improvements that reduce denials, revenue leakage, and financial risk. This position will report to the Audit Manager.
Core Responsibilities
- Lead the daily activities of the Audit team, providing guidance, coaching, and feedback to Audit Specialists and input to the Audit Manager on performance and development needs
- Assign, prioritize, and monitor daily audit workloads to meet productivity, turnaround time, and quality standards
- Perform audits of account documentation for accuracy, completeness, and compliance
- Audit billing practices, including multi-state Medicaid billing, for compliance with payer contracts, federal and state regulations (including HIPAA), state-specific reimbursement methodologies, and company policies
- Validate reimbursement accuracy and identify sources of revenue leakage
- Audit compliance with payer timely filing requirements
- Review client agency management system (AMS) access and use for retrieving remittance advice (ERAs/EOBs), payment information, and claim status
- Onboard, train, and mentor Audit Specialists on revenue cycle management, Medicaid and VA reimbursement, and audit best practices
- Identify trends in billing errors, denials, underpayments, and overpayments and recommend corrective actions
- Research payer policies and reimbursement guidelines to resolve audit findings and identify opportunities for process improvement
- Document audit findings and prepare accuracy, productivity, and trend reports for management review
- Develop and maintain audit standard operating procedures (SOPs) and departmental documentation
- Serve as the team's first point of escalation for complex audit findings and reimbursement issues, escalating to the Audit Manager as appropriate
- Foster a culture of accountability, collaboration, and client service
- Partner with cross-functional teams, such as Billing, Payment Posting, and Collections, to improve operational performance
- Other duties as assigned
Experience and Skills
- Minimum 5 years of healthcare revenue cycle management experience, including at least 3 years of healthcare billing or claims auditing experience, required
- Minimum 3 years of experience with Medicaid reimbursement processes and regulations required; multi-state Medicaid experience preferred
- At least 1 to 2 years of team lead, trainer, or similar peer leadership experience preferred
- Experience with Veterans Affairs (VA) reimbursement and claims processing preferred
- Home care or home and community-based services (HCBS) billing experience preferred
- Strong understanding of payer reimbursement methodologies and revenue cycle operations, including insurance verification, medical billing, coding validation, claims submission, denial management, and collections
- Working knowledge of HIPAA and healthcare compliance requirements
- Strong analytical skills and attention to detail, with the ability to identify trends and root causes
- Excellent written and verbal communication skills, including the ability to present audit findings clearly to staff and leadership
- Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
- Proficiency in MS Office Suite (Outlook, Word, Excel) required
Education and Qualifications
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field preferred
What We Offer
- Medical, dental, and vision benefits
- 401k retirement plan
- Paid time off
- Professional development support
Compensation
$65,000-$70,000 depending on experience