Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits) * Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies
Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits) * Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies
Managed Care Specialist
Nashville, TN · On-site
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
Managed Care Specialist
Nashville, TN · On-site
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
Compliance Auditor
Chesapeake, VA · On-site
Zone Program Integrity Contractor (ZPIC); Health Care Fraud Prevention and Enforcement Action Team (HEAT) * Participates in development of voluntary disclosures and repayments to federal and state ...
Compliance Auditor
Chesapeake, VA · On-site
Zone Program Integrity Contractor (ZPIC); Health Care Fraud Prevention and Enforcement Action Team (HEAT) * Participates in development of voluntary disclosures and repayments to federal and state ...
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
... to ZPIC goals and objectives Qualifications • Must be a graduate from an accredited U.S. college or university with a bachelor's degree and/or experience equivalent to six years of professional ...
Managed Care Specialist
Nashville, TN · On-site
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
Managed Care Specialist
Nashville, TN · On-site
Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives Qualifications Must be a graduate from an accredited U.S. college or university with a bachelor ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. About PAM Health ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 70 ...
Knowledge of MAC, RAC, ZPIC denials and process. Ability to travel as required. ABOUT US PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 70 ...
Zpic information
See salary details
$93K - $118.8K
20% of jobs
$127.2K is the 25th percentile. Wages below this are outliers.
$118.8K - $144.5K
16% of jobs
The median wage is $153K / yr.
$144.5K - $170.3K
42% of jobs
$170.3K - $196.1K
0% of jobs
$196.1K - $221.9K
12% of jobs
$221.9K - $247.6K
6% of jobs
$247.6K - $273.4K
2% of jobs
$273.4K - $299.2K
0% of jobs
$299.2K - $325K
0% of jobs
$325K - $350.7K
0% of jobs
$350.7K - $376.5K
1% of jobs
$93K
$172.7K
$376.5K
How much do zpic jobs pay per year?
What is a Zpic?
A ZPIC (Zone Program Integrity Contractor) job involves investigating potential Medicare fraud, waste, and abuse. ZPIC auditors review claims, medical records, and billing practices to ensure compliance with federal regulations. They work to identify improper payments, conduct interviews, and may recommend corrective actions or further audits. These roles require strong analytical skills and knowledge of healthcare laws.
What are the main responsibilities of a Zpic?
As a ZPIC, your daily responsibilities often include reviewing Medicare claims for irregularities, conducting audits of healthcare providers, and analyzing data for patterns indicative of fraud or abuse. You’ll collaborate with healthcare organizations, legal teams, and sometimes law enforcement to gather evidence and ensure compliance with federal regulations. The work is both investigative and analytical, requiring you to document findings and prepare detailed reports that support enforcement actions. This role also involves ongoing education to keep up with changing healthcare policies and fraud detection strategies. The position is ideal for those who enjoy problem-solving, working independently, and making a direct impact on the integrity of the healthcare system.
What skills and qualifications are needed to thrive as a Zpic?
To thrive as a ZPIC (Zone Program Integrity Contractor), you need a strong background in healthcare compliance, auditing, and the analysis of Medicare claims data, typically supported by experience in healthcare administration or fraud investigation. Familiarity with audit management tools, health information systems, and relevant certifications such as Certified Professional Medical Auditor (CPMA) or Certified Fraud Examiner (CFE) are highly beneficial. Excellent critical thinking, attention to detail, and professional communication skills are essential for managing complex investigations and reporting findings. These qualifications ensure ZPICs can effectively detect and prevent healthcare fraud, safeguarding the integrity of Medicare programs.

Full-time
Re-posted 29 days ago
Job description
Job Summary:
We are seeking a highly experienced and strategic Director of Post-Pay Audit to lead our medical revenue recovery audit teams across both onshore (U.S.) and offshore (Philippines) operations. This leader will be responsible for overseeing the execution of comprehensive post-payment audits across commercial and government payers (Medicare, Medicaid, TRICARE, etc.), ensuring compliance, accuracy, and maximum revenue recovery for healthcare provider clients.
The ideal candidate brings deep knowledge of healthcare reimbursement policies, government audit programs (e.g., RAC, UPIC, MAC), and a proven ability to lead cross-functional and cross-cultural teams at scale.
Key Responsibilities:
- Lead and manage the end-to-end post-pay audit function, including planning, execution, quality assurance, and reporting.
- Direct and support a global team of audit professionals, ensuring productivity, accuracy, and compliance across both U.S.-based and Philippines-based operations.
- Oversee audit processes related to government payers and regulatory programs (e.g., CMS RAC, Medicaid Integrity Program, etc.).
- Establish and refine audit workflows, KPIs, and escalation protocols to optimize audit yield and recovery timelines.
- Collaborate with compliance, legal, and analytics teams to identify audit opportunities and mitigate risk.
- Serve as the subject matter expert for payer audit guidelines, CMS regulations, and state-specific requirements.
- Build strong relationships with internal stakeholders and clients to align audit strategies with broader revenue recovery goals.
- Develop and execute training programs and professional development plans for onshore and offshore audit staff.
- Ensure adherence to internal quality standards, HIPAA regulations, and client-specific SLAs.
- Analyze audit outcomes and present regular performance and risk reports to senior leadership.
Qualifications:
- Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required; Master’s or MBA preferred
- Minimum of 7–10 years of experience in post-payment auditing, healthcare reimbursement, or revenue recovery
- Proven experience managing global teams, including operations based in the Philippines
- Strong knowledge of government audit programs (RAC, MAC, CERT, ZPIC/UPIC, Medicaid audits)
- Excellent understanding of healthcare billing, coding (ICD-10, CPT, HCPCS), and payer policies
- Demonstrated ability to lead process improvement initiatives in large-scale audit operations
- High proficiency with audit and recovery systems, reporting tools, and workflow platforms
- Strong communication, leadership, and analytical skills
- Certification in auditing, billing, or compliance (e.g., CPMA, CPC, CHC) is a plus
Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.
HBiz complies with all applicable employment laws for remote and multi-state hiring and provides reasonable accommodations as required by law.
About Health Business Solutions
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
51 - 200 Employees
Headquarters location
Cooper City, FL, US
Year founded
2002