Director, CERIS Audit

📋 Description

• Provide strategic leadership and operational oversight across clinical and audit review functions
• Lead strategic initiatives and continuous improvement programs across the full range of review
• Oversee clinical review, HBA, IBR, Implant, PR, and other review functions within the assigned
• Establish and maintain standardized processes, operational policies, procedures, and best practices
• Monitor operational performance throughout each audit cycle and identify opportunities to improve
• Support review scoping, product enhancement initiatives, and policy development in partnership with

🎯 Requirements

• Bachelor’s degree in Healthcare, Business Administration, or a related discipline, or 7+ years of
• Significant experience in healthcare operations, audit services, payment integrity, clinical
• 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
• Strong understanding of data analysis, reporting, and visualization, with the ability to use

🎁 Benefits

• Competitive salary range of $99,250–$166,777, with final compensation determined by factors
• 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.