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Westchester Medical Center Health Network · 1 day ago

Network Director, Compliance- Billing Integrity

Valhalla, NY

Full-time

Onsite

Director/Executive

7+ years exp

Westchester Medical Center Health Network is seeking a Network Director for Compliance - Billing Integrity who will be responsible for the strategic design, implementation, and oversight of the enterprise billing compliance auditing and monitoring program. This role involves leading a multidisciplinary team to ensure compliance with regulatory requirements and advance a data-driven billing compliance model focused on risk mitigation and continuous improvement.

Hospital & Health Care

Responsibilities

Lead and oversee the Network's enterprise billing compliance audit and monitoring program for: Professional (physician) services Hospital inpatient and outpatient services

Ensure audit scope, methodology, frequency, and documentation align with: NYS OMIG Compliance Program requirements OIG Compliance Program Guidance CMS billing, coding, and documentation standards

Develop and maintain a risk-based annual audit and monitoring work plan informed by regulatory trends, internal risk assessments, claims data, and enforcement activity

Direct physician coding audit activities, including E/M, procedural, and modifier reviews, across employed and affiliated practices

Ensure all physicians receive timely, targeted coding education based on audit findings, regulatory updates, and risk trends

Partner with physician leadership, operations, and revenue cycle to design and implement a proactive physician monitoring program that emphasizes education, early intervention, and documentation improvement

Oversee onboarding and periodic compliance education for new and existing physicians

Manage the hospital auditing program, including coordination with external audit and consulting firms

Oversee inpatient and outpatient audit activity, including DRG validation, medical necessity, and documentation reviews

Ensure consistent methodologies, defensible workpapers, and standardized reporting across internal and external audits

Serve as a primary liaison during external audits and regulatory reviews, as directed by Compliance leadership

Oversee data mining, analytics, and monitoring activities to identify billing risk, trends, and outliers

Ensure accurate tracking, trending, and validation of audit results, corrective actions, and outcomes

Develop dashboards, metrics, and executive-level reports for: Compliance leadership Executive Compliance Committee Board and Board Audit Corporate Compliance Committee

Prepare audit summaries and status reports in support of regulatory reporting and governance oversight

Maintain current knowledge of federal and state billing compliance requirements, enforcement trends, and industry best practices

Recommend and support policy, procedure, and control enhancements based on audit findings and regulatory developments

Collaborate with Compliance, Revenue Cycle, Operations, Legal, and Quality teams to implement corrective action plans and sustainable process improvements

Support a culture of compliance through education, transparency, and partnership with operational leaders

Directly supervise and develop a team of compliance auditors and data analysts

Ensure appropriate credentials, training, and ongoing competency of auditing staff

Establish clear performance expectations, workload prioritization, and professional development pathways

Qualification

Healthcare complianceBilling complianceAuditingData analyticsCertified Professional CoderRisk managementRegulatory knowledgeLeadershipCommunicationTeam management

Required

Minimum of 7 years of progressive experience in healthcare compliance, billing compliance, auditing, or revenue integrity, required

Demonstrated leadership experience managing audit teams and complex compliance programs within a hospital system or large physician enterprise, required

Bachelor's degree in healthcare administration, Business Administration, Finance, Accounting, or a related field, required

Certified Professional Coder (CPC), required

In-depth knowledge of: CMS billing and coding requirements

In-depth knowledge of Federal and New York State healthcare regulations

In-depth knowledge of NYS OMIG and OIG compliance program expectations

Strong analytical, data interpretation, and reporting skills

Proven ability to communicate complex compliance concepts to physicians, executives, and operational leaders

Demonstrated ability to lead proactive, risk-based compliance initiatives in a large, complex healthcare environment

Preferred

Experience working with external auditors, consultants, and regulatory agencies, strongly preferred

Master's degree, preferred

Additional certifications (e.g., CCS, CHC, CHPC), preferred

Company

Westchester Medical Center Health Network

Glassdoor3.2

The Westchester Medical Center Health Network (WMCHealth) is the pre-eminent provider of integrated health care in New York’s Hudson Valley region, serving nearly 2.5 million residents across more than 6,000 square miles.

Founded in 1917

Valhalla, New York, US

10001+ employees