Director of Payor Audit & Regulatory Defense (Remote)
Aeroflow Inc, Asheville, NC, United States
Director of Payor Audit & Regulatory Defense (Remote)
Aeroflow Health is seeking a seasoned Director of Payor Audits & Regulatory Defense to lead the company through a critical period of audit intensity, regulatory scrutiny, and program maturity. This role is not about maintaining a steady-state audit function, but about raising the bar and building a durable audit program capable of operating across 50 states, complex payor requirements, and heightened government oversight. Reporting to the Associate General Counsel, this leader will own government and commercial payor audits, partner closely with Legal and Compliance, and build a strong internal audit program once immediate risks are contained. This is a high-impact, high-visibility role for someone who thrives in ambiguity, understands the art and science of audits, and is not afraid to step into complexity. Your primary responsibilities include: Leading all external audits, including Medicaid, Medicare, and commercial payors Serving as the primary point of contact for commercial and payor audits Overseeing audit responses, rebuttals, corrective action plans, and appeals Partnering with Legal to ensure the company speaks with one voice during audits Tracking audit outcomes, recoupments, pre-pay activity, and financial exposure Designing and implementing a robust internal audit and monitoring program, built from the ground up Using audit findings to inform policy updates, training, and operational improvements Identifying root causes and driving sustainable remediation across teams Advising executive leadership on audit risk, mitigation strategies, and resource needs Navigating audits across multiple state Medicaid manuals, understanding the nuance and variation by state Leading and developing audit staff, setting expectations and raising performance Operating effectively within a large, multi-state, national organization Other job duties as assigned Skills for success include: Command presence in high-stakes environments, with the ability to represent Aeroflow confidently and credibly in government and commercial audit settings Exceptional written and verbal communication skills, particularly in drafting audit responses, rebuttals, and executive-level summaries Strong judgment and decision-making ability, especially when navigating ambiguity, incomplete guidance, or competing regulatory interpretations Analytical rigor, with the ability to assess audit findings, quantify exposure, and translate risk into clear business impact Cross-functional influence, including the ability to partner effectively with Legal, Compliance, Operations, and Executive Leadership Root-cause orientation, focused not just on closing audits but on preventing recurrence through sustainable remediation Organizational and prioritization skills to manage multiple audits, timelines, and stakeholders simultaneously Leadership and coaching capability, with experience developing audit talent and raising performance standards across a team Balance of precision and pragmatism, knowing when to apply strict interpretation and when to navigate toward practical, defensible outcomes Required qualifications include: Direct government audit experience, with strong preference for Medicaid Experience auditing DME or similarly regulated healthcare environments Hands-on experience managing audits across multiple states At least 5+ years of pure audit experience, with leadership responsibility Willingness to travel to Headquarters (Asheville, NC) on a monthly basis You might also have: Certified Fraud Examiner (CFE) credential Prior work with or within a Medicaid Fraud Control Unit (MFCU) or equivalent government audit authority CHC certification Experience enhancing an audit program What we look for: Thrives under pressure Enjoys solving complex problems with limited precedent Is comfortable making judgment calls when the answer is not obvious Knows how to lead people through uncertainty Can balance precision with pragmatism Wants to leave something stronger than they found it What Aeroflow Offers: Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!! Here at Aeroflow, we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements: Family Forward Certified Great Place to Work Certified Inc. 5000 Best Place to Work award winner HME Excellence Award Sky High Growth Award If you've been looking for an opportunity that will allow you to make an impact, and an organization with unlimited growth potential, we want to hear from you! Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
Aeroflow Health is seeking a seasoned Director of Payor Audits & Regulatory Defense to lead the company through a critical period of audit intensity, regulatory scrutiny, and program maturity. This role is not about maintaining a steady-state audit function, but about raising the bar and building a durable audit program capable of operating across 50 states, complex payor requirements, and heightened government oversight. Reporting to the Associate General Counsel, this leader will own government and commercial payor audits, partner closely with Legal and Compliance, and build a strong internal audit program once immediate risks are contained. This is a high-impact, high-visibility role for someone who thrives in ambiguity, understands the art and science of audits, and is not afraid to step into complexity. Your primary responsibilities include: Leading all external audits, including Medicaid, Medicare, and commercial payors Serving as the primary point of contact for commercial and payor audits Overseeing audit responses, rebuttals, corrective action plans, and appeals Partnering with Legal to ensure the company speaks with one voice during audits Tracking audit outcomes, recoupments, pre-pay activity, and financial exposure Designing and implementing a robust internal audit and monitoring program, built from the ground up Using audit findings to inform policy updates, training, and operational improvements Identifying root causes and driving sustainable remediation across teams Advising executive leadership on audit risk, mitigation strategies, and resource needs Navigating audits across multiple state Medicaid manuals, understanding the nuance and variation by state Leading and developing audit staff, setting expectations and raising performance Operating effectively within a large, multi-state, national organization Other job duties as assigned Skills for success include: Command presence in high-stakes environments, with the ability to represent Aeroflow confidently and credibly in government and commercial audit settings Exceptional written and verbal communication skills, particularly in drafting audit responses, rebuttals, and executive-level summaries Strong judgment and decision-making ability, especially when navigating ambiguity, incomplete guidance, or competing regulatory interpretations Analytical rigor, with the ability to assess audit findings, quantify exposure, and translate risk into clear business impact Cross-functional influence, including the ability to partner effectively with Legal, Compliance, Operations, and Executive Leadership Root-cause orientation, focused not just on closing audits but on preventing recurrence through sustainable remediation Organizational and prioritization skills to manage multiple audits, timelines, and stakeholders simultaneously Leadership and coaching capability, with experience developing audit talent and raising performance standards across a team Balance of precision and pragmatism, knowing when to apply strict interpretation and when to navigate toward practical, defensible outcomes Required qualifications include: Direct government audit experience, with strong preference for Medicaid Experience auditing DME or similarly regulated healthcare environments Hands-on experience managing audits across multiple states At least 5+ years of pure audit experience, with leadership responsibility Willingness to travel to Headquarters (Asheville, NC) on a monthly basis You might also have: Certified Fraud Examiner (CFE) credential Prior work with or within a Medicaid Fraud Control Unit (MFCU) or equivalent government audit authority CHC certification Experience enhancing an audit program What we look for: Thrives under pressure Enjoys solving complex problems with limited precedent Is comfortable making judgment calls when the answer is not obvious Knows how to lead people through uncertainty Can balance precision with pragmatism Wants to leave something stronger than they found it What Aeroflow Offers: Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!! Here at Aeroflow, we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements: Family Forward Certified Great Place to Work Certified Inc. 5000 Best Place to Work award winner HME Excellence Award Sky High Growth Award If you've been looking for an opportunity that will allow you to make an impact, and an organization with unlimited growth potential, we want to hear from you! Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.