Director, CERIS Audit in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, CERIS Audit based in United States.

This senior leadership role is responsible for driving operational excellence across clinical and healthcare audit review functions. You will provide strategic direction, operational oversight, and continuous improvement throughout the audit lifecycle. The role combines healthcare payment expertise, data-driven decision-making, workforce planning, and people leadership to strengthen quality, productivity, scalability, and client value. You will work closely with operational, policy, and payment integrity leaders to deliver annual objectives and support long-term growth. Success will depend on your ability to standardize processes, identify improvement opportunities, and translate complex operational insights into actionable strategies. You will also play a key role in developing teams, strengthening cross-functional collaboration, and maintaining high standards of compliance and service. This is an opportunity to shape review operations while making a meaningful impact on healthcare payment accuracy and client outcomes.

• 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.

• 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.

• 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.