Director, CERIS Audit

Accountabilities

• • Provide strategic leadership and operational oversight across clinical and audit review functions, driving quality, productivity, scalability, efficiency, and effectiveness.
  • Lead strategic initiatives and continuous improvement programs across the full range of review operations.
  • Oversee clinical review, HBA, IBR, Implant, PR, and other review functions within the assigned scope.
  • Establish and maintain standardized processes, operational policies, procedures, and best practices that enhance performance and client value.
  • Monitor operational performance throughout each audit cycle and identify opportunities to improve quality, productivity, scalability, and client experience.
  • Support review scoping, product enhancement initiatives, and policy development in partnership with broader cross-functional teams.
  • Collaborate with operational and payment integrity leadership to achieve annual objectives and advance long-term growth strategies.
  • Develop proactive workforce planning approaches to ensure review teams have the appropriate capacity, skills, and resources to meet business needs.
  • Lead, coach, mentor, and develop direct reports and other team members while fostering a culture of accountability, excellence, collaboration, and teamwork.
  • Build effective communication channels across departments and organizational levels to improve coordination and execution.
  • Use operational data, reporting, and analysis to identify trends, evaluate performance, and guide scalable process improvements.
  • Maintain strong client relationships by understanding client needs, communicating effectively, and delivering consistent, high-quality review outcomes.
  • Ensure review operations comply with HIPAA requirements and applicable organizational policies and procedures.
  • Participate in company meetings, strategic initiatives, and cross-functional projects while contributing expertise to broader organizational priorities.
  • Perform additional responsibilities as required to support operational and organizational objectives.

  Requirements

  • Bachelor’s degree in Healthcare, Business Administration, or a related discipline, or 7+ years of equivalent education and experience in operations management and third-party healthcare audit services.
  • Significant experience in healthcare operations, audit services, payment integrity, clinical review, or related environments.
  • Registered Nurse (RN) license is preferred.
  • Certified Professional Coder (CPC) certification or a comparable coding credential is preferred.
  • Extensive knowledge of healthcare payment policies, commercial payer reimbursement methodologies, billing guidelines, and healthcare audit practices.
  • Strong understanding of data analysis, reporting, and visualization, with the ability to use operational data to identify trends and drive measurable improvements.
  • Demonstrated experience leading operational teams and implementing process improvements across complex review environments.
  • Exceptional written and verbal communication skills, including the ability to translate complex healthcare and operational concepts into clear, actionable information.
  • Strong stakeholder management and consultative relationship-building skills, with the ability to influence diverse audiences and collaborate across organizational levels.
  • Excellent decision-making, analytical, organizational, and problem-solving abilities.
  • Strong strategic planning and leadership capabilities, with the ability to balance immediate operational needs with long-term objectives.
  • Proficiency with Microsoft Office applications and related business productivity tools.
  • Ability to work effectively across departments and build productive relationships with clinical, operational, policy, payment integrity, and other stakeholders.
  • Strong understanding of compliance requirements, including HIPAA, and the ability to maintain rigorous standards across review operations.

  Benefits

  • Competitive salary range of $99,250–$166,777, with final compensation determined by factors including location, experience, qualifications, internal equity, and market conditions.
  • Comprehensive benefits package for eligible full-time employees.
  • Medical coverage with HDHP and pharmacy benefits.
  • Dental and vision insurance.
  • Long-term disability and life insurance.
  • Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
  • Accident and critical illness insurance.
  • Pre-paid legal insurance.
  • Parking and transit FSA accounts.
  • 401(k) and Roth 401(k) retirement plans.
  • Paid time off.
  • Opportunity to lead high-impact healthcare audit and payment integrity operations.
  • Career advancement opportunities within a stable and growing environment.
  • Supportive culture centered on accountability, commitment, excellence, integrity, and teamwork.
  • Remote work opportunity.