Senior Manager, Compliance & Audit

Sound Physicians • ,

7d • $100,000 - $125,000 • Remote

About The Position

The Senior Manager, Compliance & Audit is responsible for overseeing the day-to-day operations of the enterprise compliance audit and monitoring program. This includes managing professional coding and billing audits, regulatory compliance reviews, risk assessments, corrective action monitoring, and compliance investigations related to clinical documentation and billing integrity. This role serves as a strategic compliance leader and subject-matter expert responsible for identifying regulatory and operational risks, supporting enterprise compliance initiatives, and ensuring adherence to federal and state healthcare regulations, payer requirements, contractual obligations, and organizational policies. The Senior Manager partners closely with Compliance leadership, Revenue Cycle, Medical Directors, Coding Compliance Educators, Clinical Documentation Optimization Champions (“CDOCs”), Operations, Legal, and Executive Leadership to strengthen audit defensibility, reduce financial and regulatory risk, and enhance organizational compliance oversight. This role protects Sound Physicians from regulatory exposure, strengthens audit defensibility, reduces financial risk, and enhances enterprise-wide compliance oversight through proactive risk identification and structured internal controls. The individual in this role will oversee compliance auditors, report to the Director of Compliance & Compliance Audit, and collaborate with stakeholders and coding compliance educators.

Requirements

• Strong knowledge of professional and hospital billing compliance.
• Strong knowledge of Medicare and Medicaid regulations.
• Strong knowledge of healthcare revenue cycle operations.
• Strong knowledge of coding and documentation requirements.
• Strong knowledge of compliance auditing methodologies.
• Strong knowledge of regulatory investigations and corrective action processes.
• Advanced understanding of ICD-10-CM, CPT, and HCPCS coding guidelines.
• Knowledge of healthcare compliance frameworks and internal controls.
• One or more of the following: RHIA, RHIT, CCS, CPC, CCS-P, CHC. (CPC preferred, with healthcare compliance, auditing, and practice management/healthcare operations experience a must)
• Advanced knowledge of ICD-10-CM and CPT/HCPCS coding guidelines/conventions and applying in varied clinical settings (i.e., hospital, ED, clinic, etc.) and/or multi-specialty areas.
• Advanced knowledge of Medicare and Medicaid program rules and regulations, and experience applying to coding and billing of hospital and professional services.
• Bachelor’s degree in healthcare administration, Health Information Management, Nursing, Business, Compliance, in a related field, or equivalent combination of experience/training in a professional and/or hospital revenue cycle setting.
• 7+ years of healthcare compliance, coding compliance, auditing, or revenue cycle compliance experience.
• Experience conducting coding and billing compliance audits for professional and/or hospital services.
• Experience with audit software, reporting tools, and compliance analytics platforms.

Nice To Haves

• 3+ years of leadership or management experience preferred.

Responsibilities

• Oversee enterprise compliance audit activities for professional and hospital-based services.
• Manage risk-based audit programs focused on coding, billing, documentation integrity, and regulatory compliance.
• Monitor high-risk billing and operational areas, including but not limited to: E/M services, Shared/split services, Critical care, Telehealth, APP supervision, Observation services, Modifier utilization, Hospice-related billing, Teaching physician services.
• Develop audit methodologies, sampling protocols, and documentation standards.
• Review audit findings and identify trends, outliers, and emerging compliance risks.
• Conduct focused audits and investigations in response to hotline complaints, payer concerns, or identified risk indicators.
• Oversee corrective action plans and follow-up audits to ensure remediation effectiveness.
• Identify and assess enterprise compliance risks related to federal and state healthcare regulations.
• Support organizational compliance with: Medicare and Medicaid requirements, CMS billing regulations, HIPAA Privacy and Security requirements, False Claims Act requirements, Stark Law and Anti-Kickback Statute requirements, OIG guidance, Commercial payer requirements.
• Support internal investigations and regulatory response activities.
• Assist with overpayment investigations and refund assessments.
• Partner with Legal and Compliance leadership on regulatory escalations and risk mitigation strategies.
• Maintain awareness of emerging enforcement trends and regulatory developments.
• Collaborate with Coding Compliance Educators and CDOCs to develop targeted education initiatives.
• Provide guidance to clinicians, operational leaders, and Revenue Cycle teams regarding documentation and billing compliance requirements.
• Support the development of compliance policies, procedures, and internal controls.
• Participate in providing education and remediation initiatives.
• Assist operational leaders in implementing corrective actions and compliance improvements.
• Develop compliance dashboards, reports, and KPI metrics for leadership review.
• Analyze audit findings, denial trends, utilization data, and payer feedback.
• Prepare reports for: Compliance leadership, Executive leadership, Compliance Committee, Board reporting.
• Maintain audit documentation and tracking systems to support audit readiness and regulatory defensibility.
• Utilize audit software and data analytics tools to identify risk patterns and monitor compliance trends.
• Supervise and mentor compliance audit personnel and operational compliance staff as assigned.
• Assist in establishing departmental goals, workflows, and performance expectations.
• Promote collaboration across Compliance, Revenue Cycle, Operations, Legal, and Clinical Leadership.
• Support a culture of integrity, accountability, and continuous improvement.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

What This Job Offers

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