Director, Healthcare Audit Services

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

The Healthcare Audit Services Director develops strategies and leads the complex audit group to ensure timely and efficient delivery of high-quality audits aligned with organization goals and client requirements. This person will be a member of the Healthcare Audit Services leadership group, led by the VP of Audit Services. The primary focus areas for this role will be SNF and others which require clinical review

Key Responsibilities:

• Collaborates with healthcare operations and other cross-functional groups to support client contract processes such as initial inquiry/RFIs, SOW and RFP bid response development, presentations, and post award implementation. 

• Develops strategies for operationalizing and executing audit plans for multiple clients in accordance with internal audit standards and relevant statements of work while achieving revenue goals and managing expenses within financial plans.

• Applies in depth level of expertise in development of policies, procedures, workflows, reporting and other infrastructure to deliver best-in-class audit services.

• Proactively identifies opportunities for process improvement, efficiency, resolving problems, preparing and completing action plans.

• Leads teams of managers, supervisors, specialists and audit staff members.  Hires and develops talent and builds effective teams with positive team environment and culture that inspires and delivers results.

• Establishes metrics and accountability for performance monitoring (productivity/quality), communicates job expectations, trends, documentation, and ensures timelines are met.

• Supports division strategy by conducting needs assessments, capacity planning, cost/benefit analyses; preparing staffing models, establishing productivity and quality standards.

• Serves as healthcare services complex audit subject matter expert (SME), maintains professional and technical knowledge of relevant regulatory and industry requirements, changes, benchmarks, best practices, and emerging trends.

• Develops effective relationships internally and externally at all levels.

• Uses excellent communication skills to influence a wide range of internal and external audiences.

• Applies in-depth understanding of the inter-relationships of the business and support units throughout the organization.

• Accepts ownership and delivers results for assigned operational group given direction in the form of broad objectives aligned with divisional strategy.

• Participates collaboratively, proactively advises, and adds value to broader division and company initiatives and problem resolution.

• Builds healthcare services value and credibility with internal and external clients and represents the organization in meetings with the client, provider organizations, contractors, subcontractors and vendors.

• Timely response to escalated inquiries, data and informational requests from the client and providers.

• Builds trust and credibility

• Other duties as assigned

Knowledge, Skills and Abilities Needed:

• Depth and breadth of healthcare industry and regulatory environment necessary to be effective in the role.

• Possesses broad and comprehensive understanding of medical claim audit standards, policies, and best practices.

• Demonstrated ability to develop effective audit strategies and operations for government and commercial healthcare clients

• Strong project and program management skills

• Makes sound decisions, exhibiting initiative and intuitive thinking.

• Consulted often by others for advice and opinions and recognized as a leadership role model.

• Complex problem solving and strong analytical skills

• Ability to lead and work collaboratively; hold accountability, coach, develop and mentor staff.

• Strong interpersonal skills with an energetic, charismatic and approachable style, and ability to navigate effectively through conflict and difficult conversations.

• Demonstrated ability to build and maintain high performing teams that deliver results

• Ability to effectively prioritize and multi task in a diverse and past paced environment

• Must be a strong effective communicator, both orally and in writing, and the ability to deliver presentations to all audiences

• Strong working knowledge of desktop applications, including but not limited to, MS Office and becomes proficient in new systems and applications quickly

Requirements & Qualifications:

• BA/ BS in Business, Healthcare or other related focus, or equivalent combination of education and experience.

• 10+ years of business experience managing within healthcare industry with increasing responsibility

• 5+ years of leadership experience within healthcare audit services or related

• Active, unrestricted Registered Nurse (RN), Nurse Practitioner (NP), or Physician (MD, DO) license is required.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant’s Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED