Overview

Be inspired. Be rewarded. Belong. At Emory Healthcare.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

Comprehensive health benefits that start day 1
Student Loan Repayment Assistance & Reimbursement Programs
Family-focused benefits
Wellness incentives
Ongoing mentorship, development, and leadership programs
And more

Work Location: Atlanta, GA

Description

The Director, Compliance Auditor - Healthcare Provider provides expert leadership in evaluating and strengthening the organization's compliance program across clinical, billing, privacy, and operational domains.

This role leads complex, risk-based compliance audits to ensure adherence to federal and state healthcare regulations and guidance from Healthcare Compliance Association, HHS-OIG, CMS, and other regulatory agencies.

The position serves as a strategic advisor to executive leadership, clinical leaders, and the Compliance Committee.

Strategic & Leadership

Lead the development and execution of the annual healthcare compliance audit and monitoring plan based on enterprise risk assessments

Advise the Chief Compliance Officer, Compliance Committee, and executive leadership on regulatory risk exposure, audit findings, and remediation priorities

Provide mentorship and technical oversight to compliance auditors, analysts, or coders, as applicable

Prepare and present executive and Board-level audit reports and trend analyses

Healthcare Compliance Auditing

Lead and perform audits to assess the design and effectiveness of internal controls, policies, and compliance safeguards in high-risk areas identified in the risk assessment

Identify root causes, systemic risks, and potential overpayment exposure

Ensure audit workpapers meet legal defensibility and regulatory standards

Regulatory & Enforcement Support

Support internal investigations related to potential fraud, waste, abuse, or regulatory noncompliance

Assist with government audits, payer audits, RAC audits, and regulatory examinations

Support overpayment identification, quantification, and repayment in coordination with Legal and Finance

Corrective Action & Continuous Improvement

Oversee development and implementation of corrective action plans (CAPs)

Validate remediation through follow-up audits and ongoing monitoring

Enhance continuous monitoring tools, dashboards, and audit methodologies

Partner with operational leaders to improve documentation, controls, and compliance culture

Additional Duties as Assigned

Travel: Travel to Emory Affiliated locations as required

Work Type: Hybrid employee - splits time between working remotely and working in the office

Minimum Qualifications

Bachelor's degree in Healthcare Administration, Nursing, Health Information Management, Accounting, Finance, or related field
7 years of progressive experience in healthcare compliance auditing, internal audit, or regulatory compliance

Knowledge, Skills & Abilities (required):

Medicare and Medicaid billing rules

Clinical documentation and coding standards

HIPAA Privacy and Security Rules

Physician compensation and contracting requirements

Proven experience conducting risk-based compliance audits in a provider environment

Excellent ability to communicate complex compliance issues to clinical leaders and executives

Competencies:

Deep healthcare regulatory expertise

Clinical and operational acumen

Executive presence and judgment

Independence and objectivity

Advanced analytical and investigative skills

Ability to influence clinicians and administrators

Preferred Qualifications

Education: Master's degree (MHA, MBA, MSN, JD, or related)
Experience: in hospital systems, academic medical centers, or multi-site provider organizations
Familiarity with EHR systems, revenue cycle workflows, and clinical operations
Experience supporting OIG audits, DOJ inquiries, CMS surveys, or payer investigations
Certification: Professional certifications strongly preferred: 1. CHC, CHPC, CHC-F 2. CIA, CPA, CFE 3. RHIA, RHIT, CCS, CPC
Reporting Relationship: Reports to the Chief Compliance Officer or VP, Compliance & Integrity

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

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