Compliance Audit Manager

Days - Full Time

Remote

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 pr