Auditor & Payer Resolution Specialist

Orthofix•Lewisville, TX

20h

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. ESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS: 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 PREFERRED QUALIFICATIONS The education, knowledge, skills and/or abilities listed below are preferred qualifications in addition to the minimum qualifications stated above. Audit Payer guidelines Project management skills Team leadership expertise PHYSICAL DEMANDS AND WORK CONDITIONS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. No additional physical requirements or essential functions for this position. DISCLAIMER The duties listed above are intended only as representation of the essential functions of this position. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer. Nothing in this document alters an employee’s at-will employment status. We are committed to providing equal employment opportunities to all employees and applicants without regard to race (including traits historically associated with race, such as hair texture and protective hairstyles, including braids, locks, and twists), ethnicity, religion, religious creed (including religious dress and grooming practices), color, caste, sex (including childbirth, breast feeding, and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age (40 and over), protected medical condition (including cancer and genetic conditions), genetic information, disability (mental and physical), reproductive health decision-making, medical leave or other types of protected leave (requesting or approved for leave under the Family and Medical Leave Act or the California Family Rights Act), domestic violence victim status, political affiliation, or any other protected status in accordance with all applicable federal, state, and local laws. This policy extends to all aspects of our employment practices including, but not limited to, recruiting, hiring, discipline, termination, promotions, transfers, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.

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.