Senior Manager, Compliance and Audit Operations

Overview

Be inspired.  Be rewarded. Belong. At Emory Healthcare. 

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide: 

• Comprehensive health benefits that start day 1 

• Student Loan Repayment Assistance & Reimbursement Programs 

• Family-focused benefits  

• Wellness incentives 

• Ongoing mentorship, development, and leadership programs  

• And more 

 

Description

Job Summary Reporting to the Corporate Director, Compliance and Audit Operations, the Senior Manager, Compliance and Audit Operations provides operational leadership and oversight for audit, monitoring, and education activities related to hospital and professional billing, coding, and documentation compliance.This role ensures Compliance and Audit Partners execute high-quality audits using consistent methodologies and deliver timely, accurate, and actionable results. The Senior Manager partners closely with the Corporate Director to support investigations, compliance inquiries, and strategic initiatives while ensuring alignment with regulatory standards and organizational compliance objectives.  Principal Duties and Responsibilities:  Oversight & Leadership Provides direct operational leadership and guidance to Compliance and Audit Partners responsible for professional and facility-based services. Ensures consistent audit standards, methodologies, documentation, and alignment with established compliance strategies. Oversees execution of audits, monitoring, and education activities to confirm compliance, identify reimbursement implications, and communicate risk areas. Supports investigations, compliance inquiries, and strategic initiatives to ensure timely completion and appropriate follow-up actions. Manages staff responsible for focused coding and billing compliance audits and special projects included in the annual departmental work plan.  Program Oversight & Policy Support Evaluates billing and coding compliance activities to assess effectiveness and ensure appropriate coverage of risk areas. Provides operational guidance for policies, workflows, and processes supporting compliant documentation, professional billing, and coding practices. Leads review and updating of billing and coding compliance policies in collaboration with the Corporate Director. Communicates applicable policies and supports operational implementation.  Audit Program Management Assists in preparation and execution of the billing and coding components of the Compliance Work Plan. Directs focused audits and reviews to assess adherence to billing compliance policies and regulatory standards. Oversees sample reviews to confirm billed codes are supported by documentation. Ensures audit reports are accurate, clear, and actionable.  Education & Collaboration Oversees development and delivery of coding and billing compliance education programs. Ensures communication of audit findings, trends, and risk areas to providers and departments. Serves as an advisor to clinical and administrative departments regarding compliance risks. Supports corrective action recommendations when appropriate.  Data Analysis & Reporting Oversees analysis of medical record documentation and billing data for audits. Maintains reporting mechanisms providing insights into audit activity and compliance trends.  Minimum Qualifications:

• Education
  • Bachelor's degree required.
• Experience
  • Minimum seven (7) years of audit experience required.
  • Minimum five (5) years of hospital/clinical coding and billing management experience required.
  • Experience with ICD-10, CPT, and HCPCS coding in multi-specialty professional and hospital/clinical billing environments required.
  • Proficiency in MDAudit Enterprise software and Epic electronic health record systems required.
• Certification
  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.

Knowledge, Skills, and Abilities:  Minimum KSAs

• Knowledge of billing, coding, and documentation requirements, including Federal and State regulations, medical necessity standards, and professional billing practices.
• Knowledge of legal and regulatory compliance requirements related to coding, billing, and documentation.
• Thorough understanding of coding documentation improvement pract