Dir Provider Audit & Reimbursement

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Dir Provider Audit & Reimbursement based in the United States.

The Director of Provider Audit & Reimbursement will lead strategic planning, operational performance, and team development across provider audit and reimbursement functions. This senior leadership role focuses on ensuring compliance with Medicare requirements, meeting contractual obligations, and delivering accurate, efficient, and high-quality services. You will guide experienced teams, oversee budgets and resources, and translate organizational priorities into actionable plans that drive performance and continuous improvement.

Working closely with internal leaders, government agencies, healthcare institutions, and other stakeholders, you will help strengthen operational effectiveness and support evolving customer needs. This remote-eligible opportunity is ideal for an experienced Medicare audit and reimbursement professional who combines technical expertise with strong leadership, analytical thinking, and a commitment to accountability.

• 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.

• 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…