Senior Director, Compliance Audit - Coding and Billing

Mosaic Health

Full Time (Monday-Friday 8AM-5PM)

REMOTE

Summary

The Senior Director of Compliance Audit for Coding and Billing is responsible for overseeing the integrity, accuracy, and compliance of coding and billing practices across the organization. This role ensures adherence to federal and state regulations, payer requirements, and industry best practices to mitigate risk and optimize revenue integrity. This role leads auditing programs, compliance training, and corrective action plans while working closely with leadership, revenue cycle teams, and regulatory agencies to uphold ethical and legal billing practices.

Essentials Duties & Responsibilities: (Include but no limited to)

• Manages and mentors a team through onboarding, open communication, training and development opportunities and performance management processes; builds and maintains exceptional employee morale and motivation.
• Interacts with senior leadership regularly to ensure an ongoing understanding of key objectives.
• Partners with and influences both peer and senior leaders to identify, manage, and mitigate compliance risks in operational areas, and provide creative and well-informed solutions.
• Collaborates with other corporate/operational functions, such as internal audit, legal, finance/accounting, revenue cycle, human resources, and business units to direct business unit compliance activities to appropriate channels.
• Performs as an idea generator, working with others as a thought leader and subject-matter expert to help brainstorm new processes and solutions to maintain compliance within all business units.
• Performs and facilitates special projects assigned by the Chief Compliance Officer.
• Performs all tasks in observance of business units' brand and strategy and adheres to their core values and service goals.
• Develops and maintains relationships with external stakeholders, such as regulators and industry associations. This includes staying up to date on new laws and regulations and industry's best practices.
• Partners and collaborates with legal and compliance/risk teams across the private equity sponsor portfolio, sharing and learning best practices and navigating complex relationships and regulations.
• Demonstrate excellent guest service to internal team members and patients.
• Perform other related duties as assigned.

Education and Certifications:

• Bachelor's degree in healthcare administration, health information management, or a related field. Masters preferred.
• Applicants must have active CPC, CPMA, or CRC certification through AAPC.
• Minimum of 7-10 years of experience in clinical coding, billing compliance, and audit leadership.
• Strong knowledge of CPT, ICD-10, HCPCS, and HCC coding guidelines, and payer reimbursement policies.
• 5+ years of experience in corporate compliance.
• CHC or CCEP certification is preferred.
• Exceptional independent judgment.
• Excellent analytical, writing, and presentation skills.

Qualifications:

• Ensure compliance with federal and state healthcare regulations, including CMS, OIG, HIPAA, and payor guidelines.
• Develop, implement, and maintain policies and procedures for coding and billing compliance.
• Stay current with regulatory changes and proactively address potential compliance risks.
• Function as a subject matter expert and liaison between internal teams and externa regulatory agencies.
• Lead comprehensive internal and external coding and billing audits to identify discrepancies and areas for improvement.
• Develop risk-based audit strategies to ensure accurate claim submission and revenue cycle integrity.
• Analyze audit findings, identify trends, and implement corrective action plans.
• Oversee the reporting of audit outcomes and communicate results to senior leadership.
• Develop and implement coding and billing compliance training programs for physicians, coders, billers, and revenue cycle staff.
• Provide ongoing education on regulatory changes, documentation requirements, and fraud prevention.
• Collaborate with clinical and business leaders to ensure proper coding and documentation practices.
• Collaborate with revenue cycle, finance, and clinical teams to improve coding accuracy and revenue integrity.
• Identify and assess risks related to coding, billing, and documentation compliance.
• Lead investigations of potential fraud, waste, and abuse, including responses to payer audits and government inquiries.
• Implement proactive strategies to prevent non-compliant billing and reduce audit risk.
• Collaborate with legal and compliance teams to address identified issues and implement remediation plans.
• Possesses exceptional people skills and the ability to communicate, concisely, and effectively.
• Strong ability to influence and gain commitment at all levels of the organization.
• Strong work ethic; unquestioned integrity, credibility, and judgment.
• Ability to work independently in a fast-paced, cross-functional environment.

Supervisory Requirements:

This position supervises coding and billing auditors.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft Word, Excel, and PowerPoint.

Certificates, Licenses, Registrations:

• Applicants must have active CPC, CPMA, or CRC certification through AAPC.

• CHC or CCEP certification is preferred.