Dir Provider Audit & Reimbursement

Accountabilities: Provide strategic leadership and direction for provider audit and reimbursement teams, projects, and services. Ensure contractual obligations, performance standards, service metrics, and applicable regulatory requirements are consistently met. Serve as key personnel for audit and reimbursement activities in accordance with relevant government, commercial, and industry requirements. Lead, coach, and develop staff by establishing clear expectations, supporting professional growth, and promoting teamwork and accountability. Manage productivity, performance, timeliness, problem-solving, and training while allocating resources effectively. Contribute to divisional and organizational strategic planning, establish short- and long-term departmental goals, and identify opportunities for process improvement. Oversee departmental budgets and resource planning to support contract requirements, operational efficiency, and performance objectives. Maintain current knowledge of provider audit and reimbursement practices, Medicare Cost Reporting, industry trends, applicable standards, and regulatory developments. Oversee responses to audit findings and ensure appropriate corrective actions and process improvements are implemented promptly. Collaborate with technical and systems development teams to create and improve tools that support operational needs. Build effective relationships with internal and external stakeholders, including state and federal agencies, healthcare institutions, project consultants, and customer representatives. Translate business strategies into actionable operational plans, using critical thinking, financial management, and project management capabilities to improve service delivery. Identify opportunities for organizational growth, innovation, and improved customer outcomes. Partner with project management, contract administration, finance, and other operational leaders to coordinate priorities and support customer commitments. Mentor management staff and develop subject-matter expertise to strengthen leadership readiness and organizational responsiveness. Uphold applicable privacy, security, compliance, and segregation-of-duties policies, including HIPAA and relevant Centers for Medicare & Medicaid Services (CMS) requirements. Requirements Bachelor’s degree in accounting or a business-related field from an accredited institution, including at least 24 credit hours in accounting, or a Certified Public Accountant (CPA) credential, together with knowledge of Medicare laws, regulations, and Government Auditing Standards; alternatively, 15 or more years of significant management experience in Medicare audit and reimbursement. At least five years of Medicare Cost Report audit and reimbursement experience, including three years managing Medicare Cost Report audit or reimbursement functions, or in an equivalent role. Demonstrated experience building and leading teams, achieving operational goals, and maintaining efficiency and service quality. Strong knowledge of Medicare Cost Reporting, provider audit and reimbursement operations, and applicable regulatory and compliance requirements. Proven leadership, interpersonal, communication, organizational, and staff-development skills. Strong analytical capabilities, including the ability to interpret data, assess performance, and make informed operational decisions. Excellent problem-solving skills and the ability to identify risks, address audit findings, and implement effective improvements. Experience with strategic planning, budget oversight, resource allocation, and performance management. Ability to collaborate effectively with senior leaders, government agencies, healthcare organizations, and cross-functional teams. Understanding of HIPAA and other applicable privacy, security, and regulatory obligations. Preferred qualifications: CPA certification, a Master of Business Administration (MBA), and at least five years of management experience overseeing complex systems and workflows. Ability to work remotely from a location within one of the 50 U.S. states or the District of Columbia. Willingness to travel periodically for in-person management meetings, with travel of up to 25%. Ability to meet the role’s office-related requirements, including prolonged sitting, computer and telephone use, effective communication, and occasional lifting of up to 15 pounds. Depending on the position’s federal access requirements, eligibility to complete applicable identity verification, background investigation, credentialing, and access authorization processes. Federal credentials may require at least three years of U.S. residency within the previous five years. Benefits Annual salary range: $104,831.40–$137,936.05. The final base salary may vary based on geographic location, internal equity, relevant knowledge, skills, and experience. Additional compensation through an incentive plan and lifestyle benefit. Remote or work-from-home eligibility. Health, dental, and vision insurance. Voluntary insurance plans, health savings accounts, and flexible spending accounts. 401(k) retirement plan with employer matching contributions. Company-paid life insurance. Education assistance and access to an online learning system. Paid sick leave, paid holidays, and a paid time off plan with increasing accrual. Medical, parental, and disability leave. Workers’ compensation and retiree benefits. Severance package. Employee assistance program and financial and health wellness benefits. Casual dress environment and an open office setting. Benefits and compensation are subject to applicable policies and eligibility requirements.