Job Description
About the position The Corporate Director Compliance Auditor - Healthcare Provider provides expert leadership in evaluating and strengthening the organization's compliance program across clinical, billing, privacy, and operational domains. This role leads complex, risk-based compliance audits to ensure adherence to federal and state healthcare regulations and guidance from Healthcare Compliance Association, HHS-OIG, CMS, and other regulatory agencies. The position serves as a strategic advisor to executive leadership, clinical leaders, and the Compliance Committee. Responsibilities • Lead the development and execution of the annual healthcare compliance audit and monitoring plan based on enterprise risk assessments • Advise the Chief Compliance Officer, Compliance Committee, and executive leadership on regulatory risk exposure, audit findings, and remediation priorities • Provide mentorship and technical oversight to compliance auditors, analysts, or coders, as applicable • Prepare and present executive and Board-level audit reports and trend analyses • Lead and perform audits to assess the design and effectiveness of internal controls, policies, and compliance safeguards in high-risk areas identified in the risk assessment • Identify root causes, systemic risks, and potential overpayment exposure • Ensure audit workpapers meet legal defensibility and regulatory standards • Support internal investigations related to potential fraud, waste, abuse, or regulatory noncompliance • Assist with government audits, payer audits, RAC audits, and regulatory examinations. • Support overpayment identification, quantification, and repayment in coordination with Legal and Finance Corrective Action & Continuous Improvement • Oversee development and implementation of corrective action plans (CAPs) • Validate remediation through follow-up audits and ongoing monitoring • Enhance continuous monitoring tools, dashboards, and audit methodologies • Partner with operational leaders to improve documentation, controls, and compliance culture • Additional Duties as Assigned Requirements • Bachelor's degree in Healthcare Administration, Nursing, Health Information Management, Accounting, Finance, or related field • 7years of progressive experience in healthcare compliance auditing, internal audit, or regulatory compliance • Medicare and Medicaid billing rules • Clinical documentation and coding standards • HIPAA Privacy and Security Rules • Physician compensation and contracting requirements • Proven experience conducting risk-based compliance audits in a provider environment • Excellent ability to communicate complex compliance issues to clinical leaders and executives • Deep healthcare regulatory expertise • Clinical and operational acumen • Executive presence and judgment • Independence and objectivity • Advanced analytical and investigative skills • Ability to influence clinicians and administrators Nice-to-haves • Master's degree (MHA, MBA, MSN, JD, or related) • in hospital systems, academic medical centers, or multi-site provider organizations. Familiarity with EHR systems, revenue cycle workflows, and clinical operations • Experience supporting OIG audits, DOJ inquiries, CMS surveys, or payer investigations • Professional certifications strongly preferred: CHC, CHPC, CHC-F, CIA, CPA, CFE, RHIA, RHIT, CCS, CPC Benefits • Comprehensive health benefits that start day 1 • Student Loan Repayment Assistance & Reimbursement Programs • Family-focused benefits • Wellness incentives • Ongoing mentorship, development, and leadership programs Apply tot his job