Director Payor Audit - Revenue Cycle

As the Director of Payer Audit – Revenue Cycle, you’ll lead a high-performing, system-wide audit team and set the strategy for pre- and post-payment audit processes. This is more than managing denials—it’s about driving payer behavior change, leveraging data to influence outcomes, and reducing financial risk across a $7B+ health system. If you’re a proven leader with deep expertise in payer audits and a passion for collaboration, innovation, and results, this is your opportunity to make a lasting impact.

The System Director of Payer Audit provides strategic and operational leadership for all payer audit functions across the health system. This role is responsible for overseeing pre- and post-payment audit processes, managing denials and appeals, and driving payer behavior change through data-driven insights and cross-functional collaboration. The Director will lead a centralized team of audit professionals, including RNs, coders,  and administrative staff. They will work closely with clinical, compliance, and revenue cycle leaders to ensure audit integrity, optimize reimbursement, and reduce financial risk.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Strategic Oversight & Leadership

• Lead the system-wide payer audit function, ensuring alignment with organizational goals and revenue cycle strategies.
• Develop and implement a centralized audit model to streamline intake, triage, appeal, and follow-up processes.

• Collaborate with stakeholders to identify audit trends, root causes of denials, and opportunities for payer negotiation and contract improvement.

Operational Management

• Oversee the intake and processing of medical record audit requests, ensuring timely and accurate responses to payers and auditors.
• Direct the development of appeal strategies and ensure high-quality, evidence-based appeal letters are submitted.
• Monitor audit volumes, cycle times, and outcomes to drive continuous improvement and resource optimization.

 Team Development & Supervision

• Manage a multidisciplinary team including audit managers, RNs, coders, and support staff.
• Define role-based workflows and skillset alignment to ensure efficient case routing and resolution.
• Foster a culture of accountability, innovation, and professional growth.

Data Analytics & Reporting

• Utilize Epic Correspondence Records and other tools to track audit lifecycle stages and outcomes.
• Provide regular reporting to executive leadership on audit trends, financial impact, and team performance.
• Partner with IT and analytics teams to enhance audit tracking and predictive modeling capabilities.

 Compliance & Collaboration

• Ensure compliance with payer policies, CMS guidelines, and internal documentation standards.
• Serve as a liaison to legal, compliance, and contracting teams on audit-related matters.
• Represent the organization in payer discussions and external audit forums.