Audit Team Lead

PARADIGM SENIOR SERVICES INC•North Miami, FL

7d•$65,000 - $70,000•Hybrid

About The Position

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.

Requirements

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
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

Nice To Haves

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

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