Dir Provider Audit & Reimbursement

Noridian Healthcare Solutions, LLC; Fargo (ND); Remote; USD 105.000 - 138.000; Vollzeit

Benefits dieser Stelle

Health Insurance

Dental Insurance

Vision Insurance

401(k) Match

Paid Holidays

Zusammenfassung

Noridian Healthcare Solutions, LLC seeks a Director of Provider Audit & Reimbursement to lead the Provider Audit & Reimbursement department, crafting strategies and plans aligning with company standards for service excellence and growth. The role oversees Medicare Cost Reporting and related activities, guiding staff with technical expertise.

The position requires strong leadership, regulatory knowledge, and the ability to drive performance and efficiency across diverse provider audits.

Qualifikationen

• Bachelor's degree in Accounting or a business-related field with at least 24 credit hours in accounting or a CPA and knowledge of Medicare laws, GAS.
• 15+ years of significant Medicare Audit and Reimbursement management experience
• 5 years Medicare Cost Report Audit and Reimbursement experience, 3 of which must be in a managerial role
• Understanding of HIPAA and related regulations
• Strong leadership, interpersonal, communication, and organizational skills
• Proven data analytical abilities and problem-solving skills

Aufgaben

• Acts as key Personnel for Audit & Reimbursement in accordance with government, commercial, and/or private industry standards.
• Provides leadership and strategic direction for Provider Audit teams, projects, and services.
• Leads by example, promoting teamwork and company values.
• Ensures contractual obligations and performance standards are met.
• Coaches and develops staff to meet performance expectations.
• Drives results and manages budgets to meet contract requirements and improve efficiency.
• Collaborates with internal/external stakeholders to coordinate efforts and information exchanges.

Kenntnisse

Leadership

Data Analysis

Communication

Organizational Skills

HIPAA Compliance

Medicare Knowledge

Regulatory Knowledge

Ausbildung

Bachelor's degree in Accounting or business

Jobbeschreibung

* Position is Eligible for Remote / Work from Home Opportunity*

• Department: Provider Audit
• Telecommuting Eligible: Yes
• Job Grade: E16
• As a condition of employment, physical work location must be in one of the 50 states or the District of Columbia.
• Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.com)

Job Title

Director Provider Audit and Reimbursement

Job Summary

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 of Provider Audit & Reimbursement is also responsible for providing staff with technical guidance regarding Medicare Cost Reporting and related activities.

Essential Functions

Key Duties/Responsibilities/Accountabilities

• 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.

Non-Essential Duties and Functions

• Other duties as assigned

Minimum 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

Above requirements and the following:

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

Environment and Cognitive/Physical Demands

• 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%

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

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, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and federal contract requirements, and (ii) eligibility to obtain and maintain federal identity credentials and authorized access to government facilities, information systems, networks, sensitive information, or applications.

To obtain federal identity credentials and authorized access, employees in this position may be required, as a condition of employment, to successfully complete federal identity verification, federal background investigation and adjudication, credentialing, and access authorization processes in accordance with applicable federal requirements. Federal identity credentials and authorized access will not be issued to candidates who have not resided in the United States at least three (3) out of the last five (5) years.

Failure to obtain and maintain eligibility for required federal credentials and access authorization may result in removal from the position or termination of employment.

Equal Employment Opportunity

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Below is the salary range for potential new hires.

Salary Range: The pay range for this position is $104,831.40 - $137,936.05 annually, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Other Compensation: Incentive Plan & Lifestyle Benefit

This job will be closed 11/09/2026 at 8:00AM CST. No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.