Director, CERIS Audit

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. Requirements 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 d