[Hiring] Director Provider Audit and Reimbursement @Noridian Healthcare Solutions, LLC

Role Description

The Director of Provider Audit & Reimbursement provides leadership to the Provider Audit & Reimbursement department and is responsible for devising strategies and plans for the Provider Audit & Reimbursement department according to the company standards for service excellence and growth. This role manages, monitors, and coordinates all provider audit and reimbursement activities of Noridian Healthcare Solutions (NHS) to meet metrics, maintain contract expectations, and promote efficiency of operations. The Director is also responsible for providing staff with technical guidance regarding Medicare Cost Reporting and related activities.

• Acts as key Personnel for Audit & Reimbursement in accordance with contractual requirements for government, commercial, and/or private industry standards, when/where applicable.
• Provides leadership and strategic direction for Provider Audit teams, projects, and services.
• Leads by example by promoting teamwork, recognition, and thought leadership while demonstrating company values.
• Ensures contractual obligations and performance standards are met.
• Coaches and develops staff by encouraging growth and ensuring staff are meeting performance expectations.
• Drives accountability through performance management by providing leadership, direction, and motivation to provider audit staff in the areas of productivity, performance, timeliness, problem-solving, and education while managing staff and utilizing resources effectively and efficiently.
• Participates in divisional and corporate strategic planning process, establishes short- and long-term goals for the department, identifies where process improvements are needed, and provides input into department budgets to ensure adequate funds are available to support performance expectations and requirements.
• Provides strategic oversight in the management of department budgets to adequately meet contract requirements and optimize efficiency.
• Maintains a comprehensive set of audit and reimbursement knowledge, awareness of trends, standards, and current events relative to Provider Audit & Reimbursement operations.
• Oversees responsiveness to audit findings and implementation of timely changes as appropriate.
• Works with technical and systems development staff to develop application tools necessary to support ongoing operations.
• Collaborates with internal and external stakeholders including state and federal agencies, institutions, representatives, project consultants, and others to assure coordination of effort and information exchanges with the appropriate management.
• Develops leading solutions and innovations by focusing on members/customers changing needs and preferences by making informed decisions incorporating critical thinking, financial management, and project management capabilities into operations.
• Translates organization business strategies into actionable plans by leveraging market and functional knowledge while aligning the mission and objectives of the unit.
• Assists in organizational and corporate growth opportunities.
• Drives results and creates accountability and enthusiasm to achieve excellent deliverables and ensures targets are sufficiently funded, resourced, and prioritized to ensure efficient outcomes.
• Represents and mentors management staff for prepared readiness to act as the area subject-matter expert to support responsiveness to the organization’s customers.
• Works closely with other operations Executives and Directors to align strategic initiatives for growth and diversity.
• Collaborates with Project Managers, Contract Administration, and Finance for each customer the department supports.

Qualifications

• Bachelor’s degree in Accounting or a business related field from an accredited institution with a minimum 24 credit hours in accounting or a Certified Public Accountant and knowledge of Medicare laws regulations and Government Auditing Standards (GAS) OR, in lieu of education, 15 or more years of significant management experience in Medicare Audit and Reimbursement.
• 5 years’ Medicare Cost Report Audit and Reimbursement experience, 3 of which must be as a manager of Medicare Cost Report Audit or Reimbursement (or equitable role).
• Understands and abides by HIPAA and other applicable regulations.
• Broad experience creating and leading teams in achieving results and maintaining efficiencies.
• Strong leadership, interpersonal, communication, and organizational skills.
• Strong data analytical skills.
• Excellent problem solving skills.

Preferred Qualifications

• Certified Public Accountant.
• Master Business Administration.
• 5 years’ management experience managing complex systems and workflows.

Requirements

• Office Environment.
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve.
• Requires prolonged sitting and telephone use.
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers.
• Infrequent lifting to 15 pounds.
• Infrequent stooping.
• Travel up to 25%.

Benefits

• Health, Dental and Vision Insurance.
• Voluntary Insurance Plans.
• Health Savings and Flexible Spending Accounts.
• 401k and Company Match.
• Company-paid Life Insurance.
• Education Assistance Program.
• Paid Sick Leave.
• Paid Holidays.
• Increasing PTO Accrual Plan.
• Medical/Parental/Disability Leave.
• Workers Compensation.
• Retiree Benefits.
• Severance Package.
• Employee Assistance Program.
• Financial and Health Wellness Benefits.
• Casual Dress.
• Open Office Setting.
• Online Learning System.