Director, Compliance Auditor

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Work Location: Atlanta GA

The Director Compliance Auditor - Healthcare Provider provides expert leadership in evaluating and strengthening the organizations 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.

Strategic & Leadership

1. Lead the development and execution of the annual healthcare compliance audit and monitoring plan based on enterprise risk assessments
2. Advise the Chief Compliance Officer Compliance Committee and executive leadership on regulatory risk exposure audit findings and remediation priorities
3. Provide mentorship and technical oversight to compliance auditors analysts or coders as applicable
4. Prepare and present executive and Board-level audit reports and trend analyses

Healthcare Compliance Auditing

1. 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
2. Identify root causes systemic risks and potential overpayment exposure
3. Ensure audit workpapers meet legal defensibility and regulatory standards

Regulatory & Enforcement Support

1. Support internal investigations related to potential fraud waste abuse or regulatory noncompliance
2. Assist with government audits payer audits RAC audits and regulatory examinations
3. Support overpayment identification quantification and repayment in coordination with Legal and Finance

Corrective Action & Continuous Improvement

1. Oversee development and implementation of corrective action plans (CAPs)
2. Validate remediation through follow-up audits and ongoing monitoring
3. Enhance continuous monitoring tools dashboards and audit methodologies
4. Partner with operational leaders to improve documentation controls and compliance culture

Additional Duties as Assigned

Travel: Travel to Emory Affiliated locations as required

Work Type: Hybrid employee - splits time between working remotely and working in the office

Minimum Qualifications

• Bachelors degree in Healthcare Administration Nursing Health Information Management Accounting Finance or related field
• 7 years of progressive experience in healthcare compliance auditing internal audit or regulatory compliance

Knowledge Skills & Abilities (required):

1. Medicare and Medicaid billing rules
2. Clinical documentation and coding standards
3. HIPAA Privacy and Security Rules
4. Physician compensation and contracting requirements
5. Proven experience conducting risk-based compliance audits in a provider environment
6. Excellent ability to communicate complex compliance issues to clinical leaders and executives

Competencies:

1. Deep healthcare regulatory expertise
2. Clinical and operational acumen
3. Executive presence and judgment
4. Independence and objectivity
5. Advanced analytical and investigative skills
6. Ability to influence clinicians and administrators

Preferred Qualifications

• Education: Masters degree (MHA MBA MSN JD or related)
• Experience: 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
• Certification: Professional certifications strongly preferred: 1. CHC CHPC CHC-F 2. CIA CPA CFE 3. RHIA RHIT CCS CPC
• Reporting Relationship: Reports to the Chief Compliance Officer or VP Compliance & Integrity

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs. 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking Occasional sitting Close eye work (computers typing reading writing) Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste chemicals/gases/fumes/vapors Communicable diseases Electrical shock Floor Surfaces Hot/Cold Temperatures Indoor/Outdoor conditions Latex Lighting Patient care/handling injuries Radiation Shift work Travel may be required. Use of personal protective equipment including respirators environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.