Job Description

Position Summary

The Director of Compliance will design, govern, and continuously improve this program, ensuring every engagement meets or exceeds OIG, CMS, HIPAA, and payer standards while delivering measurable risk reduction for clients.

Key Responsibilities

Core Duties

Governance & Policy

• Own the corporate compliance framework mapped to the OIG 7Element model
• Draft, update, and enforce documentation, coding, and audit policies—including functional separation of CDI vs. billing teams
• Chair the monthly Compliance Steering Committee; deliver board level risk reports

Audit Program Leadership

• Architect the dual coder + clinician review methodology (baseline, concurrent, retrospective)
• Approve audit sampling plans, tolerance thresholds, and corrective action workflows
• Oversee immutable audit log retention

Client Liaison & Advisory

• Serve as primary compliance contact for client CEOs/CMOs during onboarding and external payer audits
• Present quarterly compliance dashboards and KPI outcomes (error rate, denial rate, pass rate)

AI & Data Oversight

• Partner with Product to validate NeoScribe prompt updates; ensure AI output aligns with CMS medical necessity guidelines
• Review anomaly detection models and escalation rules for potential upcoding/down coding flags

Training & Culture

• Develop microlearning modules (15 min) and CME eligible webinars on documentation best practices
• Mentor offshore coding QA teams; certify adherence to AAPC/AHIMA ethical standards
• Maintain anonymous hotline & nonretaliation process

Third Party Assurance

• Select and manage independent firms for annual 200chart spot checks
• Coordinate SOC 2/HITRUST evidence related to documentation and coding workflows

Regulatory Monitoring

• Track new CMS, OIG Industry Specific CPG, and state regulations; update policies within 60 days of issuance

Required Qualifications

• Education: Bachelor’s in Health Information Management, Nursing, or related field
• Certifications (any two): CHC, CPC, CCS, RHIA/RHIT, CCDS, COC
• Experience:
• 8+ yrs leading compliance or audit functions in provider or RCM settings
• Demonstrated success defending RAC/MAC, UPIC, or commercial payer audits
• Hands on design of documentation or coding QA programs (≥10,000 encounters/month)
• Regulatory Mastery: HIPAA, HITECH, CMS E/M & HCC guidelines, OIG CPG
• Technical: Experience with multiple EHR's, familiarity with AI/ML concepts in clinical documentation
• Soft Skills: Executive presence, persuasive communication, change management, and cross cultural team leadership

Preferred Extras

• Clinical credential (RN, NP, PA, MD/DO)
• Prior experience with ambient scribe or voice AI technologies
• SOC 2 or HITRUST audit participation
• Lean Six Sigma or similar process improvement certification

Success Metrics

KPI

Target

Coding error rate across all audited clients

≤ 3 %

External audit pass rate

≥ 95 %

Denial reduction (coding/medical necessity)

≥ 25 % vs. baseline

Policy update turnaround after new regulation

≤ 60 days

Client NPS for compliance advisory

≥ 70

Travel & Work Environment

• Up to 25 % travel for client kickoffs, payer meetings, and audit defense
• Chicago HQ office presence required weekly; remote collaboration with global coder teams in India & the Philippines

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