Director, CERIS Audit

The Director, CERIS Audit is responsible for providing leadership, strategic planning, operational management, and implementation of review excellence across CERIS review operations. This position drives performance across all review functions and is accountable for continuous improvement throughout each audit cycle.

The role provides vision, guidance, and direction to all review and audit functions, primarily clinicians and certified coders, to ensure achievement of organizational goals, compliance with review standards, process improvement, positive client perception, quality and productivity monitoring, and proactive workforce planning. This position works closely with the Director of Operations and Director of Policy and Payment Integrity to support and exceed annual objectives and long-term growth strategies.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Drive operational excellence across clinical and audit review functions, with a focus on:
  • Delivering client value and enhancing client experience
  • Standardization of processes
  • Scalability of operations
  • Operational effectiveness
  • Operational efficiency
• Lead and implement strategic initiatives and operational improvements across all CERIS review functions
• Provide direct oversight of clinical and audit review operations
• Oversee Clinical Review, HBA, IBR, Implant, PR, and other review functions within scope
• Actively participate in company meetings, calls, and cross-functional initiatives
• Contribute to review scoping, product enhancement efforts, and policy development in collaboration with the broader CERIS team
• Lead by example while providing guidance, coaching, and mentoring to team members and direct reports
• Foster and promote the CorVel and CERIS culture across all employees
• Develop and maintain effective communication channels across cross-functional teams
• Continuously evaluate and enhance operational policies, procedures, and best practices
• Ensure compliance with HIPAA regulations, policies, and procedures
• Perform additional duties as assigned

KNOWLEDGE & SKILLS:

• Exceptional verbal and written communication skills, including the ability to translate complex concepts into clear, actionable information
• Strong understanding of data analysis, reporting, and visualization, with the ability to use data to drive operational improvements and scalable processes
• Proven ability to communicate effectively, influence stakeholders, and present to diverse audiences
• Strong consultative client relationship-building skills
• Proficiency in Microsoft Office applications
• Exceptional decision-making, analytical, and problem-solving abilities
• Extensive knowledge of healthcare payment policies, commercial payer reimbursement methodologies, and billing guidelines
• Strong leadership, organizational, and strategic planning skills
• Ability to collaborate effectively across departments and levels of the organization

EDUCATION & EXPERIENCE:

• Bachelor's degree in Healthcare, Business Administration, or a related field; or 7+ years of equivalent education and experience in operations management and third-party healthcare audit services
• Registered Nurse (RN) license preferred
• Certified Professional Coder (CPC) or similar coding certification preferred