Director of Internal Audit – Healthcare Compliance & Risk Management

Our client is seeking a Director of Internal Audit to provide strategic leadership and oversight of the organizations internal audit function. This role is responsible for developing and executing a risk‑based annual audit plan, evaluating internal controls, ensuring compliance with federal and state healthcare regulations, and delivering independent, objective assessments to executive leadership. The Director partners closely with Compliance, Revenue Cycle, Finance, and operational leaders to strengthen governance, mitigate risk, and promote a culture of accountability and continuous improvement.

Onsite | No Visa Sponsorship | No Relocation Assistance

Responsibilities:

Strategic Audit Leadership

• Develop, own, and execute the annual Internal Audit Workplan, including audit scope, frequency, sampling methodology, and risk prioritization.
• Lead risk assessments across operational, financial, and compliance areas to inform audit planning.
• Ensure all audit work aligns with IIA standards, internal control frameworks (e.g., COSO), and organizational policies.

Regulatory & Healthcare Compliance Audits

• Oversee audits related to CMS, OIG, OMIG, and other regulatory bodies.
• Ensure compliance with federal and state healthcare regulations, billing requirements, and documentation standards.
• Direct audits involving CPT/ICD‑9/10 coding accuracy, medical record documentation, and billing integrity.
• Review audit findings and collaborate with physicians and operational leaders to address under‑coding, over‑coding, and documentation gaps.

Audit Execution & Reporting

• Oversee audit fieldwork, documentation, testing, and reporting.
• Monitor corrective action plans and ensure timely remediation of audit findings.
• Prepare clear, timely audit reports for Executive Leadership, Compliance Officers, and the CFO.
• Serve as the primary liaison with internal departments and external regulatory agencies during audits and reviews.

Cross‑Functional Collaboration

• Partner with Compliance Officers on audits included in the Compliance Workplan.
• Work closely with Revenue Cycle, Provider Enrollment, Managed Care, Informatics, and clinical leadership to ensure accurate billing, documentation, and regulatory adherence.
• Provide guidance and clarification on compliance issues, coding questions, denials, and audit outcomes.

Leadership & Team Development

• Lead, mentor, and develop internal audit staff; promote a culture of learning, accountability, and continuous improvement.
• Build audit capacity across the organization through training, coaching, and process enhancement.
• Foster strong relationships across departments to promote transparency, ethical practices, and operational excellence.

Other Responsibilities

• Perform additional duties as assigned.
• Attend relevant conferences, workshops, and training sessions.
• Stay current on regulatory changes, CMS updates, and industry best practices.

Qualifications/Must Haves:

• Strong analytical, investigative, and problem‑solving skills.
• 5+ years of supervisory or leadership experience managing audit teams.
• Excellent communication skills with the ability to present findings to senior leadership.
• Proficiency in Microsoft Office (Excel, Word, PowerPoint) and audit documentation tools.
• Bachelor's degree in Business Administration, Healthcare Administration, Accounting, or related field.
• 10+ years of progressive internal audit or compliance experience, including 5+ years in healthcare auditing.
• Strong knowledge of CPT codes, ICD‑9/10 coding, CMS guidelines, and healthcare billing regulations.
• Deep understanding of federal and state compliance requirements (CMS, OIG, OMIG, Medicaid, Medicare)
• Ability to manage multiple priorities, meet deadlines, and operate in a fast‑paced environment.

Preferred Qualifications:

• Experience in medium-to-large healthcare systems or multi‑site organizations.
• Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar credential.
• Certified Internal Auditor (CIA), Certified in Healthcare Compliance (CHC), or related certification.