2,489 Compliance Audit jobs in the United States

Job Functions, Duties, Responsibilities and Position Qualifications:

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Position Summary: The Compliance Audit Specialist reports to the VP of Compliance and will assist with and support the compliance program activities of Clinical Pathology Laboratories (CPL). The Compliance Audit Specialist will support the compliance department through auditing/monitoring, planning, education, assessment, and other compliance program functions including any existing compliance activities, with a particular focus on clinical/billing compliance and data analytics. They will also assist with such activities as policy and procedure development and maintenance, hotline monitoring and compliance complaint investigations, and training throughout the company. This position requires 30% travel.

Principal Responsibilities:

• Auditing and Monitoring
  • Perform annual compliance department risk assessment to develop annual department work plan
  • Design data tracking systems to detect, monitor, audit and track data to aid in identifying risk areas and correct non compliances
  • Prepare compliance audit data by compiling and analyzing internal and external data
  • Manage audits of federal and state exclusion sanctions lists for employees, vendors and clients
  • Monitor annual and new hire compliance and HIPAA training
  • Review and audit revenue billing cycle functions including but not limited to, ABNs, standing orders, charge master, and denials
  • audit findings, communicate to and recommend corrective strategies to agency
  • Establish and refine, as needed, systems to effectively audit and monitor CPL compliance with rules and regulations applying to laboratory operations.
• Compliance Inspections of CPL laboratories and phlebotomy locations
  • Using established inspection tools to identify non-compliances and prepare written report
  • Provide guidance for corrective action, track completion and monitor success. Participate in employee education

• Other compliance department responsibilities
  • Communicate, promote and exemplify the Compliance Plan and Standard of Conduct to employees in a useful and understandable format
  • Provide guidance about regulations affecting laboratories to staff when requested
  • Continuous reeducation regarding current and updated regulations using sources which include Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Board of Medical Examiners, the State Department of Insurance and local carriers in each state.
  • Participate in compliance updates and education at manager meetings, phlebotomy meetings, new sales training, QI Ops calls, etc.
  • Remain current with all applicable laws, rules and regulations
  • Medicare and Medicaid Enrollment

Education:

• Bachelor's Degree; preferred concentrations; chemical, biological or medical technician, healthcare compliance, health sciences, healthcare data science, and healthcare administration.
• Preferred: Certification in Healthcare Compliance and/or Certification in Medical Coding and Billing

Experience:

• Minimum of three years in laboratory training and/or experience in a medical laboratory

Skills:

• Good knowledge of laboratory medicine at both the technical and administrative levels
• Highly developed analytical skills for both qualitative and quantitative data
• Ability to plan and lead projects following tight deadlines
• Demonstrates a high-level of attention to detail and accuracy
• Excellent communication skills - strong verbal and written skills
• Ability to exercise initiative, discretion, and judgement
• Ability to provide sound advice and guidance to managers and employees in supporting governance and compliance matters

Scheduled Weekly Hours:
40

Work Shift:

Job Category:
Administration

Company:
Clinical Pathology Laboratories, Inc.

Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

Company Description
AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas - immunology, oncology, neuroscience, and eye care - and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at Follow @abbvie on X, Facebook, Instagram, YouTube, LinkedIn and Tik Tok ( .
Job Description
Purpose:
The Director of Global Compliance Audit leads the global compliance audit function, reporting to the VP of Internal Audit, who leads team of 43. This role provides global audit assurance services and, to a lesser extent, advisory services, primarily focusing on the various global aspects of pharmaceutical and health care compliance, supported largely by AbbVie's Office of Ethics and Compliance (OEC). The Director and function assess AbbVie's controls and processes supporting areas such as data privacy, interactions with health care providers, anti-bribery and anti-competition (e.g. FCPA), and adherence to industry regulations, such as transparency reporting. The Director and their team work with various functions including Commercial, R&D, OEC, Corporate Affairs, Finance and others to plan and execute the team's assurance activities.
Responsibilities:
Team Leadership
+ Lead a team of 13 employees, including 2 Associate Directors and 11 Senior Auditors.
+ Team members are typically experienced compliance, finance, forensic professionals from Big 4 accounting firms or have similar backgrounds in finance or compliance areas.
Audit Engagements:
+ Support and collaborate with Associate Directors in planning and scoping audit engagements, including risk interviews and planning with various stakeholders.
+ Conduct an annual risk assessment of the global commercial and associated functions, develop a compliance audit plan, and seek approval from the CFO and Audit Committee.
+ Prepare and socialize numerous audit reports, which include findings and recommendations associated with the audit, timelines, and ultimately review of remediation activities.
+ Regular Cross functional engagement including strategic projects, steering committees, etc.
+ Presentations to senior leaders in R&D, Commercial, and Compliance organization.
Leadership and Development:
+ Oversee hiring, training, development, and performance reviews of staff.
+ Provide technical guidance, leadership, and coaching to build organizational talent and prepare team members for future roles outside IA.
+ Foster a learning environment for employees to realize their potential.
Audit Strategy and Governance:
+ Ensure proper systems, processes, and governance for all compliance audits.
+ Leverage enterprise data through dashboards, tools, and advanced data modeling.
+ Align and manage a demand roadmap with audit leadership priorities and ongoing projects.
+ Collaborate with peer organizations to develop an enterprise approach to operational analytics.
+ Benchmark best practices against industry standards, emerging audit expectations, and peer organizations.
Qualifications
Qualifications
+ Bachelor's degree in Accounting, Finance, or related field from a four-year college or university. Graduate degree such as MBA, MS Accounting or JD desired.
+ Professional certifications such as CIA, CPA, CFE are desired.
+ 12+ years of experience with combination of health care compliance, audit, risk management, and relevant consulting and 5+ years of people leadership experience.
+ Strong understanding of pharmaceutical industry regulations and requirements (FDA, FCPA, data privacy, Sunshine Act).
+ Excellent analytical, communication, people leadership, critical thinking, and strategic planning skills and experience working with broad and senior level leadership.
Additional Information
Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law:
+ The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range. This range may be modified in the future.
+ We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical/dental/vision insurance and 401(k) to eligible employees.
+ This job is eligible to participate in our short-term incentive programs.
+ This job is eligible to participate in our long-term incentive programs
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company's sole and absolute discretion, consistent with applicable law.
AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community.  Equal Opportunity Employer/Veterans/Disabled.
US & Puerto Rico only - to learn more, visit & Puerto Rico applicants seeking a reasonable accommodation, click here to learn more:
$156,000 - $296,500

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**_What Ethics & Compliance contributes to Cardinal Health_**
Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.
Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.
**_What is expected of you and others at this level_**
+ Manages department operations and supervises professional employees, front line supervisors and/or business support staff
+ Participates in the development of policies and procedures to achieve specific goals
+ Ensures employees operate within guidelines
+ Decisions have a short term impact on work processes, outcomes and customers
+ Ability to work in a team environment and perform multi-job functions.
+ Knowledge of medical terminology and electronic medical records.
+ Professional and/or hospital services auditing experience.
+ Exceptional Customer Service Skills.
+ Proven interpersonal communication skills.
+ Excellent time management, personal integrity and ability to maintain confidentiality.
**_Responsibilities_**
+ Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management
+ Interactions normally involve resolution of issues related to operations and/or projects
+ Gains consensus from various parties involved
+ Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.
+ Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.
+ Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.
+ Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
+ Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
+ Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.
+ Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
+ Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.
+ Provides feedback and training for physicians and staff regarding coding insufficiencies.
+ Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
+ Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.
+ Availability to assist with research of denied claims.
+ Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.
+ Supports the overall workplan of the Compliance Department.
+ Other duties as assigned.
**_Qualifications_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred- Bachelor's degree in Health Information Management, Business or related field preferred.
+ 5+ years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work, with oncology and urology coding preferred.
+ AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.) required. Auditing certification preferred.
+ Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.
+ Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
+ Ability to interpret and apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
+ Strong attention to detail with an emphasis on organizational and analytical skills.
+ Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
+ Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership, physicians, coding staff and others.
+ Prompt and efficient ability to manage shifting priorities, demands and time lines using analytical and problem-solving capabilities.
+ Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
+ Cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge preferred.
+ Previous Revenue Cycle Operations role preferred.
+ Strong communication and presentation skills.
+ Proficiency in MS Word, Excel, PowerPoint, and Outlook.
**Anticipated salary range:** $105,100 - $140,100
**Bonus eligible:** Yes
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 10/23/2025 *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (