Manager, Healthcare Compliance - Disputes, Claims & Investigations

Stout • Detroit, MI

2d • $87,000 - $195,000

About The Position

At Stout, we’re dedicated to exceeding expectations in all we do – we call it Relentless Excellence ®. Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. Impact You’ll Make As a Healthcare Compliance Manager, you will help healthcare organizations design, implement, and maintain effective compliance programs across physician practice groups, clinical laboratories, and pharmacy operations. Lead compliance program rollout across multi-site healthcare operations. Develop risk-based audit plans, monitoring activities, and gap analyses. Translate regulatory and payer requirements into practical controls, training, and corrective action plans. Partner with operational, clinical, revenue cycle, quality, HR, IT/security, legal, and finance teams. Strengthen compliance culture through clear reporting, education, and remediation support.

Requirements

• Bachelor’s degree in healthcare administration, nursing, business, public health, health information management, or a related field, or equivalent experience.
• CHC certification required; equivalent healthcare compliance certification may be considered.
• 7+ years of progressive healthcare compliance experience.
• Demonstrated experience owning compliance program rollout, risk-based audit planning, auditing and monitoring, gap analysis, corrective action development, and validation.
• Experience supporting compliance across large physician practice groups, clinical laboratory operations, and pharmacy operations.
• Strong understanding of documentation, coding, billing, medical necessity, CLIA/CAP readiness, pharmacy regulatory requirements, DEA requirements, and state board requirements.
• Strong report writing, presentation, and stakeholder management skills.
• Ability to communicate sensitive findings professionally and influence remediation owners.
• Apply strong audit fundamentals, including scoping, sampling, evidence standards, workpapers, issue classification, CAP design, and re-testing.
• Translate regulatory and payer requirements into practical workflows and controls.
• Build trust with clinical, operational, legal, revenue cycle, quality, HR, IT/security, and finance stakeholders.
• Manage sensitive issues with discretion, professionalism, and sound judgment.
• Communicate findings clearly to leadership and compliance committees.
• Balance multiple priorities while maintaining accuracy and follow-through.
• Support a speak-up culture, consistent non-retaliation practices, and sustained compliance improvement.
• Deliver Relentless Excellence® through practical guidance, responsive service, and strong execution.

Nice To Haves

• Additional credentials such as CPC, CCS, CPMA, CHPC, CTP, or other relevant certifications preferred.
• Experience managing payer or vendor audits and reporting status to senior leadership preferred.
• Experience with analytics, dashboards, audit management tools, or data warehouse reporting preferred.
• Prior leadership or supervisory experience preferred.

Responsibilities

• Lead the rollout and refresh of compliance plans, policies, SOPs, controls, training, monitoring cadence, and escalation processes.
• Build standardized compliance tools, including gap assessment templates, control matrices, readiness checklists, training plans, and CAP trackers.
• Conduct periodic compliance risk assessments and develop annual audit and monitoring workplans.
• Monitor enforcement trends, payer focus areas, and regulatory updates to adjust compliance priorities.
• Design and execute audits, monitoring activities, and gap analyses across physician practice, laboratory, and pharmacy operations.
• Prepare audit reports with risk ratings, root-cause analysis, financial or operational impact, and recommendations.
• Develop, track, and validate corrective action plans through follow-up testing and closure.
• Lead or oversee audits of professional services documentation, coding, billing, modifiers, and medical necessity.
• Partner with revenue cycle and coding teams to identify trends, reduce repeat findings, and support payer audits.
• Support lab compliance activities related to CLIA, CAP, Joint Commission readiness, document control, SOP governance, quality audits, and CAPA processes.
• Develop and maintain pharmacy compliance program components related to policy governance, regulatory change monitoring, controlled substances, audits, and inspection readiness.
• Support investigations into compliance concerns and coordinate with HR and legal as needed.
• Build and deliver role-based compliance training for providers, billing and coding teams, lab personnel, pharmacy staff, and managers.
• Maintain compliance dashboards covering audit activity, findings, CAP aging, training completion, and trends.
• Prepare recurring updates for leadership and compliance committees.

Benefits

• Competitive compensation
• Benefits and wellness options tailored to support employees at every stage of life
• Flexible work schedules
• Discretionary time off policy
• Annual bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Manager