Director of Provider Auditing and Reimbursement

Essential Functions
1. Assist the Sr. Vice Presidents of Operations
a. Regular status updates (daily operations, personnel issues, etc.)
b. Make recommendations and assist with Audit and Reimbursement
c. Long term/strategic planning
d. Coordinate/support operational organizational efficiencies
e. Strategic planning for government contracting and for-profit
business opportunities

2. Contract Administration
a. Ensure proper staffing, operational capabilities and organizational structure
b. Assist with resolving Medicare program differences (or making the
decisions when necessary)
c. Ensure compliance with CMS MIM, SOW and BPR
d. Ensure compliance with CMS contractual and performance

3. Coach and develop Audit Managers & staff to ensure appropriate
leadership and divisional support for effective administration and
oversight of staff
a. Develop leadership skills
b. Ensure and communicate results of monthly management evaluations
c. Ensure ongoing progress against employee issues to develop a
competent and highly motivated workforce

4. Develop and apply budgets necessary to effectively administer the
Medicare Part A Audit and Reimbursement program
a. Develop Part A Audit and Reimbursement administrative budgets
b. Effectively monitor/analyze ongoing budget expenditures
c. Negotiate with CMS for additional funding for ongoing operations
and/or new initiatives

5. Develop and implement programs to support ethical business practices,
through the use of internal controls, compliance programs and employee
focused codes of conduct
a. Ensure employee understanding of expectations
b. Incorporate values and behavior expectations into daily tasks
c. Ensure appropriate monitoring methods are in place
d. Monitor Federal guidelines to ensure currency in compliance

6. Travel
a. Travel to all sites as required to carry out the duties of the AVP
b. Attend local, regional and national Medicare-related meetings,
conferences, etc.

7. Consistent regular attendance is required.

In depth knowledge of the following areas:

Negotiating and government contracting
Management theories and practices
Management information systems
Accounting theories and practices
Human relations
Communication skills
Management and organization skills
Interpersonal relationship skills, motivation, negotiation and persuasion
Analyze, interpret, and relate information on issues, data, and policies;
Problem solving and analytical skills
Frequent Travel


The Audit and Reimbursement Manager/Director shall possess at minimum:

Five (5) or more years of Medicare Cost Report Audit and Reimbursement experience with a minimum of three (3) years as a manager of Medicare Cost Report Audit or Reimbursement.

A bachelor’s degree from a currently accredited institution with a minimum of 24 credit hours in accounting, or a Certified Public Accountant (CPA), and knowledge of Medicare laws, regulations and Government Auditing Standards (GAS). In lieu of education, fifteen (15) or more years of significant management experience in Medicare Audit and Reimbursement.

Other Information

This position can be located in Fargo, ND or Camarillo, CA.


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The Informatics Group Inc. is a Healthcare IT Consulting Company.  Our consultants provide their expertise to Healthcare organizations including Providers, Payers, and Life Sciences implementing a wide array of IT solutions.

We are looking to immediately employ consultants for multiple opportunities across the US. Most of these positions are traveling roles and you can live anywhere and travel to client sites weekly. Typically, work weeks are Monday thru Thursday. As an employee of The Informatics Group, you will have available to you competitive pay, health benefits, 401k, Travel Expense Reimbursement, and full resources for you to continue to grow your career.

Apply for this position