Auditor & Payer Resolution Specialist

Orthofix•Lewisville, TX

About The Position

Why Orthofix? Guided by our organizational values – Take Ownership | Innovate Boldly | Win Together – we collaborate closely with world-class surgeons and other partners to improve people’s quality of life. At Orthofix, we want team members who build relationships and share knowledge, challenge the status quo, and deliver results every day to help us achieve our vision to be the unrivaled partner in Med Tech. Our global team of over 1,600 employees brings to market highly innovative, cost-effective, and user-friendly medical technologies that heal musculoskeletal pathologies for patients and the healthcare professionals who treat them. Looking to change people’s lives? Look no further. JOB PURPOSE: DUTIES AND RESPONSIBILITIES (essential functions of position): Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Perform routine and ad hoc internal audits of federal and commercial payer accounts to verify documentation completeness, policy adherence, and billing accuracy. Manage external payer audit requests—including Medicare pre‑payment and post‑payment audits—ensuring timely, accurate, and compliant responses in alignment with payer‑defined timelines. Serve as a subject matter expert in payer documentation standards, identifying gaps related to medical necessity, clinical support, and order‑to‑cash processes. Conduct root‑cause analysis of audit findings to identify trends involving documentation quality, operational processes, sourcing issues, or data integrity; escalate risks and recommend corrective actions. Collaborate with Finance, Compliance, Operations, and Policy teams to support audit resolution, including payment audits, write‑offs, refunds, and corrective actions. Prepare and deliver audit findings, key quality metrics, and trend analyses to OTC leadership and cross‑functional stakeholders. Partner with management to design, implement, and monitor corrective and preventive action plans (CAPAs), including re‑audits to validate effectiveness. Support the development, revision, and maintenance of Standard Operating Procedures (SOPs) and Work Instructions to reflect changing payer, regulatory, and internal business requirements. Maintain ongoing awareness of payer policy updates, regulatory changes, and internal process adjustments to ensure audit practices remain current and defensible. Promote a culture of compliance, accountability, and continuous improvement across the OTC and payer interaction lifecycle. Complete all required corporate and departmental training and maintain consistent attendance. Participate in special projects and cross‑functional initiatives as assigned.

Requirements

Minimum 5 years’ experience in the healthcare industry
Critical thinking, communication and analytic skills
Exceptional computer skills including operation of Microsoft Office
Demonstrated understanding of the company’s policies and procedures
Demonstrated interpersonal skills, problem solving, and change management skills
Knowledge of both internal and external quality standards
Demonstrated time management
Ability to support various departments within the company
Ability to take an objective approach (or remain objective) while working with various departments within the company

Nice To Haves

Audit
Payer guidelines
Project management skills
Team leadership expertise

Responsibilities

Perform routine and ad hoc internal audits of federal and commercial payer accounts to verify documentation completeness, policy adherence, and billing accuracy.
Manage external payer audit requests—including Medicare pre‑payment and post‑payment audits—ensuring timely, accurate, and compliant responses in alignment with payer‑defined timelines.
Serve as a subject matter expert in payer documentation standards, identifying gaps related to medical necessity, clinical support, and order‑to-cash processes.
Conduct root‑cause analysis of audit findings to identify trends involving documentation quality, operational processes, sourcing issues, or data integrity; escalate risks and recommend corrective actions.
Collaborate with Finance, Compliance, Operations, and Policy teams to support audit resolution, including payment audits, write‑offs, refunds, and corrective actions.
Prepare and deliver audit findings, key quality metrics, and trend analyses to OTC leadership and cross‑functional stakeholders.
Partner with management to design, implement, and monitor corrective and preventive action plans (CAPAs), including re‑audits to validate effectiveness.
Support the development, revision, and maintenance of Standard Operating Procedures (SOPs) and Work Instructions to reflect changing payer, regulatory, and internal business requirements.
Maintain ongoing awareness of payer policy updates, regulatory changes, and internal process adjustments to ensure audit practices remain current and defensible.
Promote a culture of compliance, accountability, and continuous improvement across the OTC and payer interaction lifecycle.
Complete all required corporate and departmental training and maintain consistent attendance.
Participate in special projects and cross‑functional initiatives as assigned.