Senior Manager, Compliance & Audit

Description About Sound Founded in 2001 and headquartered in Nashville, TN, Sound Physicians is a nationally respected, physician-led medical group practicing in 400+ hospitals across 45 states. Our team of 4,000+ clinicians and 1,000+ business professionals across the country is united by one mission: to build exceptional clinical partnerships that unlock quality, affordable, dignified care for everyone – no matter who they are or where they live . With physician-led clinical teams and more than two decades of operational expertise, we’ve refined what it takes to consistently deliver exceptional care in hospital medicine, emergency medicine, critical care, anesthesia, and telemedicine. Why join us? A remote-first culture that values flexibility and collaboration Opportunities to grow your career while making a real impact A team that champions inclusivity, innovation, and excellence Whether working virtually or onsite at one of our practices, you’ll be part of a purpose-driven organization shaping the future of healthcare. Sound Physicians offers a competitive benefits package inclusive of the items below, and more: Medical insurance, Dental insurance, and Vision insurance Health care and dependent care flexible spending account 401(k) retirement savings plan with a company match Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy Ten company-paid holidays per year About the Team The Sound Physicians Compliance Audit Team ensures accurate documentation, compliant billing practices, and adherence to federal and state healthcare regulations. The team conducts provider audits, monitors high-risk billing areas (e.g., E/M, shared/split, critical care, telehealth), identifies potential overpayments, and supports timely corrective action and education. Through proactive monitoring and structured oversight, the team strengthens regulatory defensibility, reduces compliance risk, and protects revenue integrity across the enterprise. About the Role The Senior Manager, Compliance & Compliance Audit is responsible for overseeing the day-to-day operations of the enterprise compliance audit and monitoring program, including professional coding and billing audits, regulatory compliance reviews, risk assessments, corrective action monitoring, and compliance investigations related to clinical documentation and billing integrity. This role serves as a strategic compliance leader and subject-matter expert responsible for identifying regulatory and operational risks, supporting enterprise compliance initiatives, and ensuring adherence to federal and state healthcare regulations, payer requirements, contractual obligations, and organizational policies. The Senior Manager partners closely with Compliance leadership, Revenue Cycle, Medical Directors, Coding Compliance Educators, Clinical Documentation Optimization Champions (“CDOCs”), Operations, Legal, and Executive Leadership to strengthen audit defensibility, reduce financial and regulatory risk, and enhance organizational compliance oversight. This role protects Sound Physicians from regulatory exposure, strengthens audit defensibility, reduces financial risk, and enhances enterprise-wide compliance oversight through proactive risk identification and structured internal controls. The individual in this role will oversee compliance auditors, report to the Director of Compliance & Compliance Audit, and collaborate with stakeholders and coding compliance educators. Essential Duties and Responsibilities Compliance Audit & Monitoring: Oversee enterprise compliance audit activities for professional and hospital-based services. Manage risk-based audit programs focused on coding, billing, documentation integrity, and regulatory compliance. Monitor high-risk billing and operational areas, including but not limited to: E/M services Shared/split services Critical care Telehealth APP supervision Observation services Modifier utilization Hospice-related billing Teaching physician services Develop audit methodologies, sampling protocols, and documentation standards. Review audit findings and identify trends, outliers, and emerging compliance risks. Conduct focused audits and investigations in response to hotline complaints, payer concerns, or identified risk indicators. Oversee corrective action plans and follow-up audits to ensure remediation effectiveness. Regulatory Compliance & Risk Management: Identify and assess enterprise compliance risks related to federal and state healthcare regulations. Support organizational compliance with: Medicare and Medicaid requirements CMS billing regulations HIPAA Privacy and Security requirements False Claims Act requirements Stark Law and Anti-Kickback Statute requirements OIG guidance Commercial payer requirements Support internal investigations and regulatory response activities. Assist with overpayment investigations and refund assessments. Partner with Legal and Compliance leadership on regulatory escalations and risk mitigation strategies. Maintain awareness of emerging enforcement trends and regulatory developments. Education & Operational Support: Collaborate with Coding Compliance Educators and CDOCs to develop targeted education initiatives. Provide guidance to clinicians, operational leaders, and Revenue Cycle teams regarding documentation and billing compliance requirements. Support the development of compliance policies, procedures, and internal controls. Participate in providing education and remediation initiatives. Assist operational leaders in implementing corrective actions and compliance improvements. Reporting & Analytics: Develop compliance dashboards, reports, and KPI metrics for leadership review. Analyze audit findings, denial trends, utilization data, and payer feedback. Prepare reports for: Compliance leadership Executive leadership Compliance Committee Board reporting Maintain audit documentation and tracking systems to support audit readiness and regulatory defensibility. Utilize audit software and data analytics tools to identify risk patterns and monitor compliance trends. Leadership & Team Management: Supervise and mentor compliance audit personnel and operational compliance staff as assigned. Assist in establishing departmental goals, workflows, and performance expectations. Promote collaboration across Compliance, Revenue Cycle, Operations, Legal, and Clinical Leadership. Support a culture of integrity, accountability, and continuous improvement. Values Collaborative: Demonstrates the ability to work well with others to accomplish a goal and get the work done; takes opinions of others into consideration; includes others in the decision-making process Likes people: Genuinely enjoys engaging with and helping others; feels a sense of accomplishment through helping and working with other people Passionate: Demonstrates a genuine enthusiasm for and excitement about the work; gets others excited about work or projects they're involved in and working on Resourceful: Proactive willingness to utilize available information and tools to figure things out Strategic thinker: Demonstrates the ability to look at the big picture and proactively develop a plan of action Trustworthy: Demonstrates a high degree of integrity; keeps confidence; does what they say they will do Knowledge, Skills, and Abilities Strong knowledge of: Professional and hospital billing compliance Medicare and Medicaid regulations Healthcare revenue cycle operations Coding and documentation requirements Compliance auditing methodologies Regulatory investigations and corrective action processes Advanced understanding of ICD-10-CM, CPT, and HCPCS coding guidelines. Knowledge of healthcare compliance frameworks and internal controls. One or more of the following: RHIA, RHIT, CCS, CPC, CCS-P, CHC. (CPC preferred, with healthcare compliance, auditing, and practice management/healthcare operations experience a must) Advanced knowledge of ICD-10-CM and CPT/HCPCS coding guidelines/conventions and applying in varied clinical settings (i.e., hospital, ED, clinic, etc.) and/or multi-specialty areas Advanced knowledge of Medicare and Medicaid program rules and regulations, and experience applying to coding and billing of hospital and professional services Education and Experience Bachelor’s degree in healthcare administration, Health Information Management, Nursing, Business, Compliance, in a related field, or equivalent combination of experience/training in a professional and/or hospital revenue cycle setting. 7+ years of healthcare compliance, coding compliance, auditing, or revenue cycle compliance experience. 3+ years of leadership or management experience preferred. Experience conducting coding and billing compliance audits for professional and/or hospital services. Experience with audit software, reporting tools, and compliance analytics platforms. Salary Range This position offers an annual salary range of $100,000 to $125,000, as well as a bonus opportunity outside of base pay. Exact salary will depend on the candidate’s experience, education and geographic location. Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws. This job description reflects the present requirements of the position.  As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.  #SoundBC