Manager, Payer Clinical Services (HBA)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, Payer Clinical Services (HBA) based in United States.

This role leads the clinical and operational oversight of hospital bill audit activities across outpatient and facility reviews.

You’ll ensure audit accuracy, coding compliance, and consistently high-quality outcomes for payer clients.

The position combines people leadership, clinical expertise, quality assurance, client service, and operational improvement.

You’ll coach and develop clinical staff while creating training programs that strengthen performance and expertise.

You’ll analyze denial patterns and audit trends to identify opportunities that improve revenue performance and client outcomes.

Working closely with clinical, coding, nursing, and client teams, you’ll translate findings into clear recommendations and actionable improvements.

This is an opportunity to shape scalable audit practices while contributing to a collaborative, technology-enabled healthcare environment.

Accountabilities

• Oversee hospital bill audits, including outpatient and facility reviews, ensuring accuracy, compliance, and adherence to internal policies and industry-standard guidelines.
• Apply relevant coding guidelines, payer policies, and clinical references to support high-quality audit reviews and consistent outcomes.
• Identify quality gaps, operational challenges, and improvement opportunities, translating findings into targeted staff education and process enhancements.
• Build and maintain strong client relationships by understanding client needs, addressing concerns, communicating audit findings, and ensuring compliance with applicable payer requirements.
• Analyze denial trends and other client data, communicate findings to clinical and coding teams, and help identify opportunities to improve revenue performance.
• Lead onboarding and ongoing training for clinical staff on technology, regulatory changes, coding requirements, and operational processes.
• Develop educational tools, communicate performance expectations, and ensure team members have the knowledge and resources required to succeed.
• Provide clients with detailed historical and current trend reporting and present findings clearly to clients, coding teams, and nursing teams as appropriate.
• Coach, mentor, and develop clinical staff using a collaborative, servant-leadership approach focused on quality, accountability, and professional growth.
• Prepare, deliver, and coordinate client communications supporting audit findings and recommendations.
• Maintain required professional certifications and continuing education, while staying current with evolving coding, billing, and regulatory requirements.
• Contribute to policy development, quality assurance initiatives, and process improvements that strengthen audit operations and client satisfaction.

Requirements

• Active coding certification such as CCS, CPC, or CIC is required.
• Registered Nurse credentials are preferred.
• Extensive experience overseeing hospital bill audits, itemized bill reviews, and high-dollar facility audits involving inpatient and outpatient claims.
• Previous experience leading or managing teams, with a demonstrated ability to coach employees, manage accountability, and drive quality performance.
• Experience developing and delivering training for new and existing team members.
• Strong knowledge of CPT, HCPCS, ICD-10, revenue codes, CMS requirements, and industry-standard coding guidelines.
• Solid understanding of inpatient and outpatient facility coding and billing practices.
• Experience with policy development and quality assurance is highly valued.
• Strong analytical, organizational, communication, and client-service skills, with the ability to interpret complex information and communicate findings clearly.
• Ability to identify trends, investigate issues, prioritize competing demands, and translate audit findings into practical recommendations.
• Familiarity with clinical documentation improvement is a plus.
• Experience with machine learning or artificial intelligence applied to healthcare or payment integrity is a plus.
• Familiarity with Encoder, Codify, TruCode/TruBridge, 3M, WebStrat, or similar coding and audit platforms is advantageous.
• Comfortable working extensively with computers and software in a primarily sedentary, remote work environment.
• Willingness to complete applicable compliance requirements associated with client and business-partner engagements.

Benefits

• Annual salary range of $90,000-$120,000.
• Comprehensive compensation package designed to support employee well-being and professional growth.
• Health insurance coverage.
• 401(k) retirement plan with employer matching.
• Paid parental leave.
• Collaborative and innovative work environment.
• Opportunities for training, professional development, and continued education.
• Reasonable workplace accommodations available for qualified individuals with disabilities.
• Opportunity to contribute to healthcare payment integrity and initiatives focused on reducing waste while improving collaboration between payers and providers.