Healthcare Network Director, Compliance- Billing Integrity

HealthAlliance of the Hudson Valley

Medicine and Health

Valhalla, NY - USA

Manager / Team Leader

Experteer Overview

In this role you will lead the enterprise billing compliance program across the WMC Health Network, ensuring adherence to CMS, OMIG, and OIG requirements. You will guide a multidisciplinary team of auditors and analysts, partnering with Revenue Cycle, Operations, and Medical Staff Leadership to mitigate risk and improve documentation integrity. You will drive data-driven monitoring, analytics, and education initiatives to advance proactive compliance and sustainable process improvements. This position offers scope to shape enterprise billing strategy and controls at scale within a hospital-system environment.

Responsibilities

Oversee enterprise billing compliance audit and monitoring for professional and hospital services
Develop a risk-based annual audit plan aligned with regulatory trends and internal risk assessments
Direct physician coding audits (E/M, procedures, modifiers) and education programs
Manage hospital auditing programs and coordinate with external auditors/consultants
Lead data mining, analytics, and governance to identify billing risk and measure outcomes
Prepare dashboards and executive reports for Compliance leadership, committees, and the Board
Maintain regulatory knowledge and drive corrective action plans with cross-functional teams
Direct team development, training, and performance management

Key requirements

Minimum 7 years in healthcare compliance, billing compliance, auditing, or revenue integrity
Experience leading audit teams within a hospital system or large physician enterprise
Experience with external auditors, consultants, and regulatory agencies
Bachelor’s degree in healthcare administration, business, finance, accounting, or related field
Certified Professional Coder (CPC) required; additional certifications preferred
Strong analytical, data interpretation, and reporting skills
Ability to communicate complex concepts to physicians and executives

leadership clear communication collaboration CMS billing and coding requirements NYS OMIG and OIG compliance program expectations data analytics and dashboard reporting

Description

In this role you will lead the enterprise billing compliance program across the WMC Health Network, ensuring adherence to CMS, OMIG, and OIG…

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