Director, Compliance

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. Compliance Program Leadership: Support the Chief Compliance Officer in advancing CUIMC's Compliance Program. Monitor the 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 and Tripartite Compliance Committee. 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 and 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, and split/shared services. Monitor and interpret evolving federal and state regulations and translate requirements into actionable compliance strategies. Audit, Monitoring, and Systems Expertise: Design and implement a 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. Partner with Departmental and Revenue Cycle teams to enhance system controls, edits, and compliance-related configurations. Analyze audit and billing data trends