Director, Compliance

Position Summary

The Director of Compliance is a leadership role within the Compliance Department responsible for overseeing and advancing the organization’s professional fee compliance, billing integrity, and regulatory adherence programs. This position directs a broad and comprehensive academic medical center compliance program, ensuring compliance with CMS regulations, federal and state laws, and applicable coding guidelines. The Director contributes to the success of CUIMC’s mission provides strategic direction and operational leadership for a team of compliance professionals, supports provider education and dispute resolution, and partners closely with Revenue Cycle, Clinical Departments, Legal, and Leadership to mitigate risk and promote compliant billing practices across a large academic medical center.

Responsibilities

Compliance Program Leadership

• Support the Chief Compliance Officer in advancing CUIMC’s Compliance Program.
• Monitor the Compliance Program, including reporting metrics, and develop regular reporting materials for the Clinical Compliance Committee and Board.
• Represent Compliance on University committees including the Ambulatory Care Network, Tripartite Compliance Committee, and others.
• Lead and develop a team of compliance professionals (auditors, analysts, educators), setting priorities aligned with organizational risk
• Oversee audit program design and execution, including statistically valid sampling, targeted audits, and corrective action plans.

Revenue Integrity & Regulatory Expertise

• Serve as the final decision-maker on complex coding, billing, and documentation issues, including interpretation of CMS regulations, NCCI edits, LCDs/NCDs, CPT/AMA guidelines, and payer policies.
• Provide authoritative guidance on professional fee billing, including global surgical package rules, modifier usage, incident-to services, split/shared services, and emerging regulatory changes.
• Monitor and interpret evolving federal and state regulations; translate requirements into actionable compliance strategies.

Audit, Monitoring, and Systems Expertise

• Design and implement risk based technical and professional billing compliance auditing program.
• Provide oversight of audit tools and technologies, ensuring effective use of audit software platforms and data analytics tools.
• Leverage EPIC EHR expertise to support audit workflows, documentation review, and reporting capabilities.
• Partner with Departmental and Revenue Cycle teams to enhance system controls, edits, and compliance-related configurations.
• Analyze audit and billing data trends to identify systemic risks and opportunities for improvement.

Provider Engagement & Dispute Resolution

• Facilitate resolution of complex or sensitive issues with physicians and clinical leadership, balancing compliance requirements with operational realities.
• Deliver clear, credible, and diplomatically communicated guidance to gain provider alignment.

Education & Communication

• Prepare and oversee the execution of employee training programs and materials to make sure all staff levels are aware of compliance guidelines.
• Develop and deliver compliance education to physicians, departments, and leadership on compliance risks and regulatory updates.
• Promote a culture of compliance through proactive engagement and transparent communication.

Strategic Leadership & Collaboration

• Partner with senior leaders across Compliance, Revenue Cycle, Legal, and Clinical Departments to align on enterprise risk priorities.
• Contribute to strategic planning and resource allocation within the Compliance Department.
• Support external audits, regulatory inquiries, and investigations as needed.

Minimum Qualifications

• Bachelor’s degree required; advanced degree (e.g., MHA, MBA, MPH) strongly preferred.
• CHC (Certified in Healthcare Compliance) or CHC-related credential.
• CPC, CCS-P, or equivalent coding certification.
• Minimum 7 years of progressive healthcare compliance, coding, or revenue integrity experience, including 5 years in a leadership or management role, preferably within an academic medical center or large physician enterprise.
• Deep expertise in:

-CMS regulations and reimbursement methodologies
-CPT/HCPCS coding guidelines and documentation requirements
-Professional fee billing compliance

• Demonstrated leadership experience developing compliance and audit infrastructure and managing high-performing compliance teams.
• Expert-level proficiency in EPIC EHR (reporting, documentation review, audit workflows), Epic certification preferred.
• Expert knowledge and experience with audit and compliance software tools (i.e. Audit Manager, MD Audit) and data analytics platforms.
• Strong track record researching cutting-edge/experimental treatments and complex coding and documentation requirements, including related coding and billing rules.
• Proven experience presenting to executive leadership and physician audiences.
• Expert knowledge of the General Compliance Program Guidance issued by the HHS OIG and the DOJ’s Evaluation of Corporate Compliance Programs, as well as fraud, waste, and abuse laws (Stark Law, Anti-Kickback Statute, False Claims Act).
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and improve efficiency of compliance operations.

Preferred Qualifications

• CPMA (Certified Medical Professional Auditor)
• Epic certification.