Compliance Audit Manager

Position Summary / Career Interest:

The Professional Audit & Compliance – Revenue Assurance Manager provides strategic leadership and operational oversight for the organization's professional compliance audit program, with a strong emphasis on Evaluation & Management (E/M) services, specialty‑specific documentation standards, and risk‑based internal audit practices. The role leads a team of compliance auditors, delivers high‑quality internal reviews, implements corrective action and targeted education, and partners with clinical, coding, and revenue cycle leaders to reduce risk and improve documentation accuracy and compliance. The Manager works in close partnership with the Director, Revenue Assurance and Auditing to align audit priorities, escalate significant findings, and maintain enterprise visibility. The Manager also provides focused oversight of the Compliance/Physician Educator to ensure education content aligns with audit outcomes and current regulations.


Responsibilities and Essential Job Functions

• Lead, mentor, and develop a team of professional compliance auditors, including workload planning, quality reviews, performance coaching, and skills development.
• Direct the execution of risk‑based internal audits with a focus on E/M services, procedural coding, and specialty‑specific documentation patterns.
• Oversee internal peer reviews, auditor calibration, and inter‑rater reliability processes to promote consistency and accuracy.
• Maintain and optimize compliance audit systems, risk‑scoring tools, and workflow technology solutions.
• Lead weekly audit team huddles, ongoing work prioritization, and timely communication of program updates.
• Work collaboratively with the Director to align departmental work with enterprise risk and strategic direction.
• Drive the development and refinement of the annual and in‑year professional audit plan, including risk‑scoring methodology, sampling strategies, scopes, and timelines.
• Define and maintain standard work for audit planning (objectives, criteria, evidence, reporting templates) to ensure consistency and repeatability.
• Align annual and in‑year audit priorities with the Director, Revenue Assurance and Auditing; provide options and impact assessments to support strategic decisions.
• Escalate systemic or high‑impact issues with concise summaries of risk, potential financial/regulatory exposure, and recommended remediation paths.
• Contribute audit results and insights to leadership and compliance committees, enabling enterprise‑level visibility and governance.
• Ensure educator training content reflects audit findings, regulatory changes, and organizational priorities.
• Review key educator deliverables (training schedules, completion reports, targeted modules) for quality and alignment.
• Confirm that audit‑identified risks are addressed through targeted education and re‑evaluation when needed.
• Conduct and oversee risk‑based professional documentation and coding audits with emphasis on E/M leveling.
• Conduct complex audits of provider documentation, coding accuracy, and billing practices for compliance with CMS, federal, state, payer, and organizational standards.
• Evaluate E/M documentation under current CMS guidelines, including time‑based services, MDM‑based leveling, split/shared rules, procedures and regulatory updates.
• Recommend corrective actions, including education, workflow refinement, and monitoring.
• Lead cross‑functional corrective action plans with clear owners and due dates; verify implementation and effectiveness via monitoring or re‑audit.
• Synthesize trend analyses (by provider, specialty, location, payer, and service type) to prioritize interventions and inform leadership decisions.
• Partner with Revenue Cycle and Compliance leadership to refine internal controls that support compliant billing practices.
• Contribute audit data and analysis for the annual compliance risk assessment.
• Support compliance investigations related to provider documentation, coding, or billing concerns through structured evidence review and regulatory analysis.
• Monitor and interpret updates from CMS, OIG, MACs, and commercial payer bulletins affecting professional billing and E/M documentation.
• Translate regulatory change into audit criteria and education content; adjust the audit plan and methodologies accordingly.
• Maintain a change‑log and communicate concise updates to stakeholders with expected operational impacts and effective dates.
• Translate audit findings into clear, targeted education for providers, coding teams, and operational staff.
• Partner with the educator and department leadership to develop scalable educational materials and reference tools.
• Communicate trends, risks, and opportunities to stakeholders at appropriate intervals.
• Collaborate closely with HIM/Coding, Revenue Cycle, Legal, HR, Clinical Operations, and IT to ensure coordinated compliance efforts.
• Establish a formal audit‑to‑education closed loop: convert findings to targeted education, schedule post‑education re‑audit within defined intervals, and report improvement rates.
• Coordinate with the Compliance/Physician Educator to align curriculum, delivery modality (live, virtual, micro‑learning), and competency checks to risk and audience needs.
• Contribute to the ongoing development, revision, and implementation of professional billing compliance policies and procedures.
• Prepare audit metrics, dashboards, and compliance reports for leadership, system committees, and year‑end compliance summaries.
• Ensure accurate use of audit tools, workflows, and dashboards to support transparency and consistency.
• Maintain audit dashboards that track key metrics (error rates, severity, corrective action status, re‑audit outcomes) and support committee reporting.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree
• High School Graduate
• 8 or more years of professional coding, E/M auditing, compliance, or related experience.

Preferred Education and Experience

• Experience mentoring or leading staff preferred.

Required Licensure and Certification

• Certified Coding Specialist(CCS) - American Health Information Management Association (AHIMA) OR
• Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) OR
• Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) OR
• Registered Health Information Administrator(RHIA) - American Health Information Management Association (AHIMA) OR
• Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC)

Preferred Language Skills

• Fluent English -

Knowledge Requirements

• Strong working knowledge of medical terminology, ICD-9, CPT, and HCPCS coding
• Experience with word processing, spreadsheet, and database software
• Excellent written and oral communication skills
• Strong analytical, communication, and provider engagement skills.
• Expert knowledge of E/M guidelines, CPT/HCPCS, ICD‑10‑CM, CMS rules, and payer policies.
• Proficiency with audit platforms and EMR systems (Epic preferred).

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.